Darden Executive Education: Application

TEP Application

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: 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 Name:
M.I.
Surname:
Shirt Size:
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:
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?

Additional Information
A fee of $36,700 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:
Mailing Address:
City/State/Zip:
Country:

Cancellation/Transfer Policy Cancellations after April 17, 2009, are subject to an $18,350 fee. Cancellations after May 15, 2009, 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 May 8, 2009. All transfers will incur a $5,505 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 $9,175 fee. A transfer request followed by a subsequent cancellation will be subject to the applicable cancellation fees noted above. All cancellations and transfers must be received in writing and sent to: Nancy Stahon, Director of Finance Darden Executive Education P.O. Box 7186 Charlottesville, VA 22906-7186 StahonN@darden.virginia.edu Email address of person recommending you:
A user-friendly, self-paced computer software package on the fundamentals of financial accounting and reporting is available. If you believe you could benefit from a review of balance sheets, income statements, cash-flow statements, financial ratios, and present-value analysis, please check the box below.
Yes, please send me the software package on the fundamentals of financial accounting and reporting (Available only in CD-Rom format).

Our experience has shown that both participants and organizations gain more from The Executive Program when the participants have a clear understanding about why they were selected to attend and what learning objectives are particularly important. 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.

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.

Please Note: Because The Executive Program employs active methods of instruction, participants must be proficient in reading, speaking, and listening in English in order to benefit from this educational experience. If English is not your native language and you do not regularly read business publications written in English, we strongly suggest that you begin doing so several months prior to TEP.

Personal Data
Title:	Mr., Mrs., Ms., Dr.
First Name:
M.I.
Surname:
Preferred/"Nickname":
Shirt Size:
Address to which TEP correspondence and materials should be sent (cannot be P.O. Box): Home Business
Business P.O. Address:
City, State ZIP:
Country:

Business Street Address:
City, State ZIP:
Country:

Business Phone:
Business Fax:
Email Address:

Home Address:
City, State ZIP:
Country:

Home Phone:
Home Fax:
Birthday (MM/DD/YY):

Languages other than English in which you are reasonably fluent:
Citizenship:
Spouse/Partner:Mr., Mrs., Ms., Dr.