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Executive Leadership Development Program

APPLICATION FOR ADMISSION

Please answer all questions.

This application must be fully completed and signed, and the Sponsoring Statement and organizational chart must be received, before review by the Admissions Committee.

Please have your sponsoring executive complete the enclosed Sponsoring Statement. This statement may be sent directly from the sponsoring official to the Admissions Committee or, if appropriate, may be sent together with the application.

Please type or print legibly.

I certify that all the information and accompanying material provided in connection with this application are authentic and accurate.

Signature of the applicant

Date

General Information

Name

Date of birth

Country of citizenship

City

State

Gender(Tick appropriate one)

Male Female Transgender

Title or Position

Company or Organization Address

Company/ Organization Telephone

Zip code/ Postal Code

Company/Organization Website

Your Home Address

Home Telephone

Mobile Telephone

PREFERRED MAILING ADDRESS

Business

Home Address

Confidential :

The information you provide below is for use by the Admissions Committee only.

Organization

Your Company/Division

Products/Services:

Annual Sales Volume: (INR)

Number of Employees:

How many Employees are under your direct Supervision?

What is the Title of the Person to whom you Report to?

How many Reporting Levels are above you, including the CEO of the parent company ?

PLEASE CHECK YOUR CURRENT INDUSTRY (check one only):

WHAT FUNCTION BEST DESCRIBES YOUR POSITION? (Check one only):

ANNUAL COMPENSATION (INCLUDING BONUS) IN RUPEES (check one only):

< INR 20,00,000

INR 20,001,000 - INR 30,00,000

INR 30,001,000 - INR 50,00,000

INR 50,00,000 - INR 75,00,000

>INR 75,00,000

Work Experience

Please list your positions in reverse chronological order, starting with your current, or most recent one. If all positions are in the same company, Please give the major promotional sequence.

Name of the Company

Title or Position

From (MM/YYYY) To MM/YYYY

Professional Achievements

Please list professional awards conferred on you during your professional career or Equivalent level in curricular, co-curricular and extracurricular activities at district, state and national level

Please Estimate your total years of Professional Experience

Please Provide a brief description of your organization and/or business unit

Please Describe your current responsibilities, including your level in the organization. Also indicate whether you have profit-and-loss (P&L) responsibility in your current role.

Please Explain your Objectives and Goals as they relate to attending this program. Also describe what you think other program participants may learn from you(i.e perspectives, skills, expertise)

What do you anticipate your career progression will be over the next five years?

What are the most formidable Challenges facing your organization and/or Business Unit?

EDUCATION

Please indicate, by typing the options - (Strong, Moderate or none) in the content box which describes the amount of prior experience and familiarity you have with each of the following areas or activities.

General Management

Human Resource Management:

Information Technology

Finance and Financial Analysis:

Accounting and Control

Marketing

Production or Operations:

HOW DID YOU LEARN ABOUT THIS PROGRAM?

Direct Mail package

Social Media

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Internet Search

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Executive Leadership Development Program Application Form