The Executive Program (TEP) Application



Please Note:
Applicants must be proficient in the English language.  All classes, discussions, and reading materials are in English.
Personal Data
Title: Mr., Mrs., Ms., Dr.
First/Given Name:
M.I.
Last/Family Name:  
Gender: Male  Female
Name for Badge:
TEP Shirt Size:
Address to which TEP correspondence and materials should be sent:
  Home  Business
Address:  
City, State ZIP:  
Country:  
Phone:  
Fax:
E-mail Address:
Birthday (MM/DD/YY):
 

Languages other than English in which you are fluent:

Citizenship:

Spouse/Partner:Mr., Mrs., Ms., Dr.
International Applicants

You will receive an invitation letter to assist with your travel to the United States. To expedite this process, please provide the following information:
Country:  
Passport ID # (if applicable):  
Passport #:  
Passport Issue Date:  
Passport Expiration Date:  
 

The Guest Program (25-28 June 2013):
If you plan to bring a guest who requires a VISA letter, please provide the guest’s name and passport information in the space below.
Guest: Mr., Mrs., Ms., Dr.
First/Given Name:  
M.I.  
Last/Family Name:  
Country (guest’s passport issued):  
Passport ID # (if applicable):  
Passport #:  
Passport Issue Date:  
Passport Expiration Date:  
 
Organization Data
Name of Your Organization:
Industry:
Your Title/Position:
What function best describes your position?
Please specify if you selected "Other":
Name of Parent Organization (if applicable):
Industry of Parent Organization:
 
Education
University/College Major Degree Year
 
Executive Education Programs Attended - Last 5 Years (include company programs)
University or Organization Name of Program Year Attended
 
Employment History - Last 10 Years (List the most recent first)
Organization Title/Position Year(s)
 
List Your Areas of Expertise
1.
2.   
3. 
4. 
 
Job Responsibilities

1. Describe your present duties and responsibilities. Include the number of people, amount of sales revenue, total assets under your managerial responsibility, the length of time you have held your present position, and your reporting responsibilities within the organization.

2. What do you find are the most challenging aspects of your job?

3. What do you see next in your career?

Program Expectations

1. What specific objectives do you have for attending The Executive Program (TEP)?

2. In what ways do you believe you will enhance the learning experience of the other TEP participants?

Billing Information
A fee of $43,000 for The Executive Program—which includes tuition, lodging, most meals, teaching materials, and certificate of participation—is due and payable upon acceptance of the participant.

Person to whom the invoice should be mailed:
Name:  
Title/Position:  
Company Name:  
Business Mailing Address:  
City/State/Zip:  
Country:  
Business Phone:  
Email Address:  
 
Cancellation/Transfer Policy
  • Cancellations after 12 April 2013 are subject to a $21,500 fee.
  • Cancellations after 10 May 2013 are assessed the entire program fee. If necessary, the sponsoring company may, by agreement with the Director of Executive Education, substitute a replacement prior to 4 May 2013.
  • All transfers will incur a $6,450 transfer fee. One transfer per accepted applicant to the next subsequent offering is allowed. Transfer requests received less than 30 days before the start date will incur a $10,750 fee. A transfer request followed by a subsequent cancellation will be subject to the applicable cancellation fees noted above.
  • Send all cancellation/transfer notices to Nancy Stahon, Director of Finance, Executive Education, Darden School of Business, University of Virginia.
Email:

StahonN@darden.virginia.edu
Phone:

+1 434-982-2005
Mail:

Darden Executive Education
P.O. Box 7186
Charlottesville, VA 22906-7186
As a matter of policy, the Darden Graduate School of Business Administration does not discriminate among applicants and participants on the basis of race, religion, sex, national origin, color, or disability.
Email address of person recommending you:   
Additional Information
How did you hear about this program?
Please provide name or specify:
If accepted into TEP, I commit to being an active participant in all aspects of the program—in class, in learning teams, and in other program activities.
On-line submission of this document confirms the candidate's agreement to all terms and conditions as outlined in this application. 


Executive Education programs are offered by the University of Virginia’s Darden School Foundation, a nonprofit organization devoted entirely to the welfare of The Darden School. The Darden School Foundation fully supports equal opportunity in employment and access to educational opportunities.
 

Information subject to change without prior notice.


Copyright © 2013 Darden