APPLICANT NAME

EXECUTIVE STREAMAPPLICATION FORM 2 0 1 0

I N T E R N A T I O N A LP R O G R A M M E

( )

The University of Hong Kong-Fudan University

Application RequirementsIMBA (Executive Stream)

Application DocumentationsApplication Form

1

To Applicant

Shall hold a bachelor degree from a recognized university or college of advanced education;

Shall be a manager who has more than 7 years of exceptional business experience at senior management level;

Preview is required.

(for Executive Stream only)

Please print boldly and legibly. All sections must be completed.

“ ”All the blanks must be completed in English except special marks. It will facilitate assessment by all members of the Selection Committee.

8 7

http://www.fdsm.fudan.edu.cn/hgmbaThe Application Form can be downloaded from our website: http://www.fdsm.fudan.edu.cn/hgmba

*

*

*

*

2

Application Fee

320 ( )Application Fee RMB320 (Irrefundable)

Payment Post Office Remittance or Cash:

Two Reference Letters

( )The two references should have adequate knowledge of the applicant’s basic information working achievements and management ability. The letters should be written in the blank recommendation form and enclosed in special envelopes with seal. (It’s suggested that one of the references should be the immediate supervisor of the applicant.)

Educational Certificate and University Transcript

(

)Please submit a copy of graduation certificate, degree certificate and official university transcript.

(GMAT/TOEFL/IELTS)English Test Certification(GMAT/TOEFL/IELTS)

580 GMAT TOEFL 550 ( 213 80 ) IELTS

6GMAT 580+/TOEFL 550+/IELTS 6+ or full-English bachelor courses approved by two universities are eligible for exempting the admission English test.

Interview

Interview Arrangement will be informed by Programme Office.

670

702

- IMBA

200433

Ms. Beiwen Zhang

HKU-FUDAN IMBA Programme

School of Management, Fudan University

Room702, Starr Building, #670 GuoShun Road.

Shanghai, China 200433

3

Please stick your business card here

1

-The University of Hong Kong-Fudan University2009 ( )2009 MBA (International) Application Form

PART A

( )Name

( )Name in Chinese Characters Date of Birth Age

D M Y

Registered Permanent Residence

( )Address For Correspondence ( )

Telephone Fax

Mobile E-mail

Urgent Contact Person

Contact

Have you previously applied for the HKU MBA?

If so, for which year(s)?

2

Mr. Ms. Mrs.

Surname Given name

( Business)

( Home) ( Home)

( Business)

No Yes

Post Code

2

Graduate degree

Date graduate degree granted

Graduate major

Undergraduate degree granting institution

Undergraduate area of study

Date undergraduate degree granted

Undergraduate degree earned

Bachelor of Arts Bachelor of Science

Bachelor of Engineering

Business Administration Humanities

Economics Mathematics

Education Science

Other (please specify)

Other (please specify)

None Doctoral degree

Master’s degree

M Y

/

M Y

/ /

( 9)

(See page 9 for code number that bestdescribes your current industry status)

Current employer

Department( )

Number of years of full-time work at enrollment

Job title( )

Industry

Engineering Social Science

Other(please specify)

/Company Character: Government/Organization State-Owned Enterprise Private Enterprise Foreign-Invested Enterprise

Others

Job Function: Top Management Human Resource Marketing Supply Chain

Finance/Accounting Production Operation Information Technology Purchasing/Sales

Others

3

Education

Please list all colleges or universities at which you have taken course. (Attach officially certified transcripts, with a complete record of the courses attended and examination results, for ALL tertiary level studies.)

, ,If you have attended more than one undergraduate institution, other than as an exchange student, briefly indicate the reasons for your transfer.

Test InformationGMAT/TOEFL/IELTS

GMAT/TOEFL/IELTS Score

// - / ( )

Degree/diplomaearned

(or expected)

Dates attendedm/y - m/y (no. of yrs)

Full orPart-time

Major Awarding Institution(state country)

Date of Awardm/y

- ( )

- ( )

- ( )

- ( )

Total ScoreTest Name( / )

Test Date(Month/Year)

Total ScoreTest Name( / )

Test Date(Month/Year)

Professional Qualifications

( )(Attach officially certified documentary evidence)

Activities

List your current and/or post-collegiate community activities in order of their importance to you.

Type of Membership Abbreviation Awarding Institution/

Date of Awardm/y

Activity/ - /Dates

m/y-m/yPosition held, if any Time required per week

4

Please list honors, awards, or other recognitions (academic, community etc.) you have received

MBAReasons for interest in this programme

? , MBA

?Please provide below a statement explaining why you are interested in doing this programme, why you are suitable for it and the value of the MBA programme to your future career. (You may use additional sheets if needed.)

5

6

Full-time Employment

Describe each full-time position you have held, beginning with your current or most recent position. Use the same format on additional sheets if needed.

Employer

Job Title No. of Subordinates

Location

How long have you worked in the present position

Annual salary (included subsidies & allowances)

Your responsibilities

Employer

Job Title No. of Subordinates

Location

How long have you worked in that position

Annual salary (included subsidies & allowances)

Your responsibilities

Reason for leaving

1. 7. 8.

2. Google.com

3. MBAHome.com Baidu.com

4. ChaseDream.com Yahoo.com

5. Hi-mba.com

6. /

9.

10.

7

Official Referees

Please list below the two individuals you have asked for recommendations.

1. 2.

Name Name

Position Position

Organization Organization

Full mailing address( ) Full mailing address( )

Signature Date

IMBASources of Information on the HKU-FUDAN IMBA

Declaration

I hereby apply to register as a candidate for the degree of Master of Business Administration(International). The information provided by me in support of this application is accurate and complete.

Check List

(Please check the following as your prepare to submit your application:

8

Transcripts(

(

GMAT (

320Application Fee

Please Note: All the submitted Application Documents will not be returned to applicant.

Please leave blank of the page below

Received Date

Receipts of Application Documents

_________________________ 2010 Executive Stream。

Transcripts(

(

GMAT (

320Application Fee

01 Commercial banking02 Diversified financial services03

Insurance04 / Investment banking/ Brokerage05

Investment management06

Venture capital

12Consulting

13 Education14 Entertainment15 Restaurant and hotel management16 Government17 Healthcare services18 Import/Export/Trading companies19 Law20 Charitable organizations21 Real estate22 Retail23 Transportation services24 Utilities25 Other non-manufacturing

26 Auto and other transportation equipment27 Chemicals28 Electronic Equipment29 / / Food/Beverage/Tobacco30 / Forest products/ Packaging31 / Household/ Personal Products32 Machinery33 / / Pharmaceutical/ Biotechnology/ Healthcare products34 / Printing/Publishing35 / Textiles/Clothing36 Other Manufacturing

07 Accounting 08 /

Advertisement/ Marketing services09 Communications services10

Computer services11

Construction

Manufacturing

2Industry Codes (for use on page 2)

Please select the industry code that best describes your current professional activity.

Financial Services

Non-Manufacturing

9

1

MBA ( )Confidential Statement of Qualifications

To the applicant

Name

Current Address

*

Address the envelope provided to yourself. It may help you to meet deadlines if you indicate to your referee the date by which you must receive this form (see below*). Be sure to give both the form and the envelope to your referee. The sealed envelope is to be sent to the Room 702, Starr Building, No.670 Guo Shun Rd. School of Management, Fudan University with your other application materials. The comments will be used for admissions purposes only and will not become part of your permanent file.

To the referee:

- MBA

IMBA

The person named above is an applicant to Fudan University - The University of Hong Kong School of Business joint IMBA program. The admissions committee attaches considerable weight to the statements made by the referees the applicant has selected. You will greatly assist the members of the committee and the applicant by completing this form. It is recommended that you keep a copy for your files in case the original should be lost in the mail. The committee is aware of the time necessary to prepare such an assessment and gratefully acknowledges your help. The comments will be used for admissions purposes only and will not become part of a student's permanent file. Under the provisions of the Personal Data (Privacy) Ordinance, applicants have the rights to request access to their personal data. We would be pleased to provide you with additional information about our program if it will assist in any way.

Please return the form in the envelope addressed to the applicant after sealing and signing your name across the flap.

*

* The applicant requests that you return the form to him/her by

date to be filled in by applicant

PART B

2

Name of referee

/Position/Title

/ /College/Firm/Institute

Address

1. ? How long have you known the applicant and in what context? Please comment on the frequency of your interaction?

2. ? What are the applicant's principal strengths?

3. ? In what areas can the applicant improve?

4. , / MBA ? In your opinion, has the applicant given careful consideration to his or her plans for entry into the MBA programme?

( )please print or type

5. Please evaluate the following aspects of the applicant.(choose the most impressive ones)

/Interpersonal Skills/Team Work

Communication Skills

Analytical and Problem Solving Ability

Innovation Ability

Leadership Ability

Professionalism

Others

Please give your overall evaluation

Strongly Recommend Recommend Recommend with reservation

May we call you if the admissions committee feels that it would be helpful to speak with you by phone regarding the applicant?

If yes, please provide us with your daytime telephone number:

Strength Average Weakness

Signature

Date Please attach business card

3

1

MBA ( )Confidential Statement of Qualifications

To the applicant

Name

Current Address

*

Address the envelope provided to yourself. It may help you to meet deadlines if you indicate to your referee the date by which you must receive this form (see below*). Be sure to give both the form and the envelope to your referee. The sealed envelope is to be sent to the Room 702, Starr Building, School of Management, No.670 Guo Shun Rd. Fudan University with your other application materials. The comments will be used for admissions purposes only and will not become part of your permanent file.

To the referee:

- MBA

IMBA

The person named above is an applicant to Fudan University - The University of Hong Kong School of Business joint IMBA program. The admissions committee attaches considerable weight to the statements made by the referees the applicant has selected. You will greatly assist the members of the committee and the applicant by completing this form. It is recommended that you keep a copy for your files in case the original should be lost in the mail. The committee is aware of the time necessary to prepare such an assessment and gratefully acknowledges your help. The comments will be used for admissions purposes only and will not become part of a student's permanent file. Under the provisions of the Personal Data (Privacy) Ordinance, applicants have the rights to request access to their personal data. We would be pleased to provide you with additional information about our program if it will assist in any way.

Please return the form in the envelope addressed to the applicant after sealing and signing your name across the flap.

*

* The applicant requests that you return the form to him/her by

date to be filled in by applicant

2

Name of referee

/Position/Title

/ /College/Firm/Institute

Address

1. ? How long have you known the applicant and in what context? Please comment on the frequency of your interaction?

2. ? What are the applicant's principal strengths?

3. ? In what areas can the applicant improve?

4. , / MBA ? In your opinion, has the applicant given careful consideration to his or her plans for entry into the MBA programme?

( )please print or type

5. Please evaluate the following aspects of the applicant.(choose the most impressive ones)

/Interpersonal Skills/Team Work

Communication Skills

Analytical and Problem Solving Ability

Innovation Ability

Leadership Ability

Professionalism

Others

Please give your overall evaluation

Strongly Recommend Recommend Recommend with reservation

May we call you if the admissions committee feels that it would be helpful to speak with you by phone regarding the applicant?

If yes, please provide us with your daytime telephone number:

Strength Average Weakness

Signature

Date Please attach business card

3

1

Transcript Request

To the applicant:

(

, )Please complete the first part of this form and send it to the Institute from which the transcript is requested.

Name

University/College attended:

Dates of attendance: From to

Title of degree/diploma:

Date of award:

MBAProgramme applying for admission at The University of Hong Kong: MBA

To the officer responsible for issuing transcripts:

MBAThe applicant named above has applied for admission to the MBA programme at The University of Hong Kong.

)

Please send one copy of the official transcript with this form directly to:

200433

670

702 IMBA

BeTogether BeBetter

- ( )The University of Hong Kong-Fudan UniversityMBA(International) Programme

670 702200433

Room 702, Starr Building, School of Management,Fudan University, No. 670, Guoshun Road,Shanghai, 200433, P. R. China

Tel: 021-65119023Fax: 021-65646975Email: shberc@fudan.edu.cnWeb: http://www.fdsm.fudan.edu.cn/hgmba