WELA webforms

China Europe International Business School (CEIBS)
Women Entrepreneurship & Leadership
for Africa Programme (WELA)
Registration Form

Application Checklist

Copies of academic certificates Two recent ID-size photographs A current CV

Fields marked are compulsory

1. Personal Information

Dr. Mrs. Ms.

Last Name

First Name

Date of birth

Place of birth

Country

Nationality

2. Permanent Address

Street

P.O. Box

Town/City

Post code

Country

Home phone

Mobile phone

Fax

E-mail (must be valid until program start)

3. Business Address

Company Name

Position

Street

P.O. Box

Town/City

Post Code

Country

Home Phone

Mobile Phone

Fax

E-mail (must be valid until program start)

4.Source of Funding

Percentage funding by company %

Percentage funding by self %

Percentage funding by other sources %

Statement of Accuracy:

I hereby certify that the information contained in this application is complete and correct to the best of my knowledge.

Date:

Applicant's signature (Please provide your full name):

* Please keep us informed, should your contact information change during the application process.

How would you prefer us to communicate with you?

By post By e-mail By telephone