CEEC Programme Application Form Send completed forms to: [email protected]Post: Woxsen School of Business Plot No 1267, 2nd Floor Gateway Jubilee, Road No. 36 Jubilee Hills, Hyderabad, India 500014 T: +91 40 4444 8888 This form is to be completed by the applicant to the programme. It must be completed in full before we can process your application. Personal information Title* Mr Ms Mrs Dr First name* Last name* Gender Male Female Nationality* Date of Birth* / / DD MM YYYY Address 2 City* Country* Address 1* State* Postal code* Telephone* Mobile Email* Employment information Organisation* City* Country* Job title* State* Postal code* Telephone* Mobile Email* Website Date of employment* / / DD MM YYYY Address 2 Address 1* Programme Name
Post: Woxsen School of Business Plot No 1267, 2nd Floor
Gateway Jubilee, Road No. 36Jubilee Hills, Hyderabad, India 500014
T: +91 40 4444 8888
This form is to be completed by the applicant to the programme. It must be completed in full before we can process your application.
Personal information
Title* Mr Ms Mrs DrFirst name*
Last name*Gender Male FemaleNationality* Date of Birth* / /
DD MM YYYY
Address 2
City*
Country*
Address 1*
State*
Postal code*Telephone* Mobile Email*
Employment information
Organisation*
City*
Country*
Job title*
State*
Postal code*Telephone* Mobile Email* Website
Date of employment* / /DD MM YYYY
Address 2Address 1*
Programme Name
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Typewritten Text
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mohan
Typewritten Text
Industry sector
Agriculture
Auto
Banking
Chemicals
Consumer Products & Services
Energy
Finance
Food & Beverage
Government
Information Technology/ ITeS/ BPOs
Retail
Real Estate
Health, Pharma
Manufacturing
Media
Mining & Metals
Not for Profit
Telecom
Trading
Travel & Transportation
Utilities
Infrastructure
FMCG
Consumer Durables
Others Please specify
How many people report to you directly?
Number of years of relevant work experience*
Reporting to (Job title)*
Additional questions
What are the 3 main responsibilities in your current role?*
What are your personal and professional development objectives in attending this programme?*
Job function
Administration
Advertising
Market Research
Business Development
Engineering, Design, R & D
Finance, Accounts, Audit
General Management
Human Resources, Industrial Relations
Information Services
Learning & Development
Manufacturing, Production, Maintenance, Quality
Marketing
Operations
IT, Project Management
Strategy & Planning
Professional Services (Doctors/Lawyers/Consultants etc.)
Purchase, Logistics, Supply Chain Management,
Sales
Others Please specify
Please briefly describe the emerging changes in your industry and/or business unit and the likely impact on your role?
How did you hear about Woxsen and the programme*I attended a School event/Information session
I read about the School in the press
Woxsen School of Business Website
My HR department recommended the School
Recommended by a colleague/friend
Event
Newspaper/ Magazine Advertisement
Online Social Media
Mailer
Others Please specify
Were you recommended for this programme? Tell us the name and job title of the person who recommended you.
Previous employment (Give details of your two most recent jobs)
Employment 1:
Job title*
Job function
Organisation *
Industry sector
Date of employment* / /DD MM YYYY
From / /DD MM YYYY
To
Employment 2:
Job title*
Job function
Organisation *
Industry sector
Date of employment * / /DD MM YYYY
From / /DD MM YYYY
To
Company Sponsorship details
Education (Give details of your two most recent qualification)
SpecializationDegree / qualification you gained
Institution or accrediting body*Year you gained your qualification
Education 1: Type of qualification
Undergraduate DoctoralPostgraduate None
SpecializationDegree / qualification you gained
Institution or accrediting body*Year you gained your qualification
Education 2: Type of qualification
Undergraduate DoctoralPostgraduate None
Previous Executive Education attendance
Name of Business School attendedProgramme title
Year you attended
Your sponsoring executive could be a Financial or Human Resources Director or Manager, or anyone authorisedby your organisation to form a contractual relationship with Woxsen School of BusinessTitle* Mr Ms Mrs DrFirst name*
Last name*
Job title*
Address 2
City*
Address 1*
State*
Postal code*Fax Number
Country*
Telephone*
Email*
Relation with the applicant Reporting Manager Other Please SpecifyHR
Organisation*
This must be the email address of the Sponsoring Executive.
DateName
Confirmation
By submitting this form, I hereby confirm that I have read and accepted Woxsen’s cancellation policy. I also confirm that I am authorized by my organisation to form a contractual relationship with Woxsen in connection with this booking.
Job TitleName
EmailPhone Number
HR Contact (HR professional responsible for Learning & Development)
Payment information & Invoicing details
Please specify below the address where the Invoice needs to be sent Sponsoring Company Other (specify the details below)Home Address
Name and address invoice should be sent toTitle* Mr Ms Mrs DrFirst name*
Last name*
Job title*
Country*
Address 2
City*
Address 1*
State*
Postal code *Telephone* Fax NumberEmail*
Organisation*
This must be the email address of the Invoice Contact
Payment DetailsCheque/Draft No
Drawn On
Date
Please send payment with this form. Cheque/draft should be drawn in favor of “Pinakin Educational Trust” payable at Hyderabad. We will acknowledge the receipt of payment to the address mentioned above.
Mail DD To Centre for Executive Education and Consulting (CEEC) Woxsen School of BusinessPlot No. 1267, 2nd Floor,Gateway Jubilee, Road No. 36, Jubilee Hills, Hyderabad, India - 500033
Please Note: Payment made 30 days before the programme start date can be made by cheque. Payment made less than 30 days before programme start date will require payment by Demand Draft. Request you to send the payment at least 20 days before the programme start date to initiate programme formalities.
Cancellation policyIn the event of participant cancellation, the following schedule will apply
I accept the terms and conditions* Yes No
6 weeks and above
Full Refund
4-6 weeks
50% of the programme fee
Less than 4 weeks
No Refund
Should we be unable to accept your application for any reason, your payment (cheque/draft) will be returned to you. In case of refunds of online payments, bank charges will be deducted.
At Woxsen School of Business we are committed to working with individuals and organisations to identify the right people for the right programmes to produce the right outcomes. We value diversity and promote a positive work and study environment. Admissions decisions are taken in accordance with best practices and each applicant is considered on his/her own merit. If you would like assistance in identifying the right programme for you, contact us directly and we'd be delighted to help.
Application form can be submitted either by: • Click the ‘Submit’ button and the form will be auto attached to your email. If using your official email id for this option, Outlook would need to be configured as your default email. or • Download and the save the form onto your computer. Attach the form and email it to [email protected] or • Print and post/ courier the form to the address mentioned on Page 1.
