Application for SEP Admission

Contact Details

Title: Mr.    Ms.    Mrs.    Dr.
Name (English): (First)	(Middle Initial)    (Last)
Name (Thai): (First)	(Last)
Nationality:	Date of Birth (Month/Date/Year)
Position (English):	(Thai)
Company Name (English):	(Thai)
Company Address:
Company Website:
Telephone:	Fax:
Email:	Mobile Phone:
Home Address:
Telephone:	Fax:
List language other than English in which you are fluent:

Personal Information

Please describe any health condition that requires special attention

In case of emergency, contact (Name, Address and Phone Number)

Education

Institution Attended:	Major/Degree/Cert. Conferred:	Year Received:
Have you previously attended any other university executive education program? If so, please provide details:
Name of University:	Program Name:	Dates Attended:

Organization Information (Present Employment)

Name of Organization:
Sales Per Year:	Net Assets:
Number of Employees:	Number of Products/Services:

Sector

Private Sector

State Enterprise

Government Sector

Type of Organization:
Investment Banking	Insurance and Diversified Financials	Service Industry
Energy	Commerce and Real Estate	Agro Industry
Manufacturing Industry	Other (Please specify):

Areas of Management

Please indicate your proficiency in the following areas. "High" = major job reponsibility and/or formal education, "Some" = working familiarity, and "Little" = unfamiliarity.
	Little	Some	High
Information Technology
Marketing
Organization Behaviour
Finance
Quantitative Skills
Human Resources/Industrial Relations
Strategic Management

Please check your current function (Check one only):
Accounting Control	Engineering	Finance	Fundraising
General Management	Human Resources	Information Services	Law
Logistics	Manufacturing/Operations	Marketing	Medicine
Planning	Product Development	Project Management	Public Relations
Purchasing	Research and Development	Teaching	Other

Salary

Monthly salary, including bonus:

Experience

Please describe your career, chronologically, including positions held before working with your current employer.
Organization name	Position held	Years of experience

Information about Current Position

Describe your present reponsibilities, including the number of employees under your supervision and/or provide a copy of your position description.*

Describe your position as it relates to the total organization, including your reporting responsibilities and the number of levels between your position and that of the organization's top management. Please include an organization chart.*

*please mail or fax to Executive Education Office

Expectations

What do you expect to accomplish by taking the Senior Executive Program? What do you expect to learn and how do you expect to apply it? Do you anticipate any specific benefits? If so, please state them.

Sponsor's Information

Sponsor's Name:

Title:

Company:

Address:

City:

Country:

Telephone:

Email:

A sponsor may voluntarily add any information deemed appropriate to action this application, but no statement or endorsement is required. It is understood that during attendance at the Senior Executive Program, the participant will be free of other duties and will not leave except in emergency situations. It is further understood that any cancellation must be received in writing from the applicant's sponsor.

Please tell us how you heard about the Senior Executive Program (check all that apply):

Previously attended another Sasin seminar

Brochure mailing

Referral: If yes, please identify your referral source:

HR/Corporate Development/Training Department  Senior Management  Past Participant of this course (SEP Alumni)  Colleague  Alumni

Ad/Article/Directory: If yes. please provide the name of the publication

Newspaper (Please specify: )  SEP Alumni Newsletter  Other

Internet Search

Sasin/Chulalongkorn University network

Direct Email

Sasin reserves the right to change without notice any statement concerning but not limited to rules, policies, tuition fees, curricula and courses.

This Application Form should be completed and submitted online, with attachments sent via fax or mail to:

Senior Executive Program
Sasin Graduate Institute of Business Administration of Chulalongkorn University
Sasa Patasala Building
Phyathai Road, Bangkok 10330, Thailand.

Tel: (66) 0 2218 4004-8 Ext. 164-167
Fax: (66) 0 2216 1314

E-mail: ExecEd@sasin.edu