LOGO APPLICATION FORM
Executive Education Programme
 
All information in this form will be treated as confidential and will only be used by CEIBS Admission Committee.
 
Application Checklist
Application Form
Photocopies of all degree certificates(certificated tanslations if degree is not in English
Corporate Sponsorship Letter or Letter of Support
Non-refundable Application fee: 50 US Dollars
C.V
Two Passport pictures
Copy of Business Card
 
Programme Name: Programme Date:
Programme Name: Programme Date:
Programme Name: Programme Date:
 
Personal Information
Please fill in with a check mark: Ms.
Are you CEIBS Alumni? Yes, please specify your class No
Name: Name in Chinese
(if applicable):
  Last(Family) Middle First  
Nationality: Date of Birth:
Business Telephone: Fax:
Mobile Phone: E-mail:
Native Language: Highest Education:
Job Title: No. of employees you
are responsible for:
 
Company Information
Company Name:
Company Name in Chinese:
Company Address (Street Address, City, Province/State, Country, Postal Code):
Annual Sales (in ¥ or US$):
Parent Company: Origin of Parent Company:
Nature: State-Owned Enterprise Private-Owned Enterprise

Wholly-Owned Foreign Enterprise

Joint Venture

 
How did you hear about the programme?
Advertisement, please specify name of publication and issue date:
Course information package received by mail
Course information received by fax
Course information received by e-mail
CEIBS Executive Forum, please specify city and date:
Recommended by CEIBS Account Manager
Recommended by colleague or friend
CEIBS website (www.ceibs.edu)
Other:
 
What industry are you in?
Aerospace/Aerospace Equipment Government
Pharmaceutical/Health Care Automotive
Hospital/Hospital Investment Power/Power Equipment
Business Consulting/Business Service Hotel/Resort
Real Estate/Infrastructure Chemicals
IT/Hi-Tech Retailing/Wholesaling/Trading
Consumer Product Manufacturing
Telecommunications Electrical
Material Textile/Garment/Leather
Electronics Media/Culture
Transportation/Logistics Financial Service/Insurance
Petroleum/Oil/Gas Conglomerate
Food/Beverage Paper/Printing/Packaging
Other, please specify:
 
Executive responsible for management development in your organisation
Please fill in with a check mark: Ms.
Name: Job Title:
Company Address:
Business Telephone: Fax:
E-mail:
 
To whom the invoice should be sent? (Should this section not be completed, the invoice will automatically be sent to the applicant.)
Please fill in with a check mark: Ms.
Name: Job Title:
Company Address:
Business Telephone: Fax:
E-mail:
 
I certify that all the information is authentic and accurate.
 
Signature of Applicant: Date:
 
Sponsoring Executive
Please have a senior executive from your organisation complete the following:
Name of Organisation:
nominates this applicant for the programme. It is understood that this applicant, if admitted, will be
completely free of official duties while participating in the programme and that the sponsoring
organisation assumes responsibility for payment of the programme fee.
 
Signature of Sponsoring Executive: Date:
Please fill in with a check mark: Ms.
Name: Job Title:
Company Address:
Business Telephone: Fax:
E-mail:
 
Note:
The full fee must be paid no later than 15 days before the start of the programme. Applications made
within 15 days of the start of a programme require immediate payment. If a confirmed booking is
cancelled within 15 days of the start of the programme, or if the applicant fails to attend the programme,
a cancellation fee equaling to 20 percent of the total programme fee will be charged.