Westbrook
University
International
Postgraduate Program
PERSONAL DATA FORM
Dear Sir or madam,
I am filling this
Personal Data Form as a part of my request to be accepted in Westbrook
University International Postgraduate Program.
·
( ) MBA
·
( ) EMBA
·
( ) DBA
·
( ) MA
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( ) PhD
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PERSONAL INFORMATION
Name ___________ ____________ __________
(last) (middle) (first)
Prefix □ Mr. □ Mrs. □ Ms. □ Miss □
Birth date (MM/DD/YYYYYYYY)
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Country(ies) of Citizenship
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Birthplace
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Telephone (Country Code) (Area Code)
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Email Address
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May we contact you via email?
□ Yes □ No
Ethnic Origin (optional).
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Gender □ Male □ Female
Mailing Address
Street
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City
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State/Province
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Zip/Postal Code
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Country
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Address Valid (MM/DD/YYYY) From ................ To ..............
TESTING INFORMATION
-GMAT
Test date (MM/DD/YYYY):
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Please list your GMAT score:
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-Other Evidence of Management study aptitude
Name of Document:
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Evaluation Criteria:
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Test score:
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Test date (MM/DD/YYYY):
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-TOEFL
Test date (MM/DD/YYYY):
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Please list your TOEFL
score: .....................................
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-Other Evidence of English Proficiency
Name of Document:
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Evaluation Criteria:
.......................................................
Test score: ....................................................................
Test date (MM/DD/YYYY):
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ACADEMIC INFORMATION
List all colleges (most recent first), graduate, and professional
schools attended regardless of whether a degree was obtained.
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Institution
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Degree Awarded
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Enrollment Period
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Major
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Date Conferred
or Expected
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From To
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What was your GPA of your undergraduate study? ____________ what
was your GPA of your post-baccalaureate degree (if applicable)? _____________
If GPA is not available, please indicate the grade scale of your
undergraduate study and your
score._____________________________________________________________________________________________________
Have you ever studied or worked other than in your own country? If
so, where? ___________________________________
Languages in which you are capable of doing business?
__________________________________
Speaking? __________________________________ Reading? ____________________________
CERTIFICATES
List the professional licenses or certificates you hold
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
EMPLOYMENT HISTORY
Total months of full-time work experience from month of
undergraduate graduation to month you would start the POSTGRADUATE
program_______________________________________________________
Please describe the 3 most recent positions you have held (list
your present or most relevant job first). In addition, enclose a resume
accounting for all of your time since graduating from high school. Do not
leave this section blank or refer to resume.
I. Employer __________________________________ Job Title
___________________________
Address ________________________________________________________________________
City ________________________________________ Country
____________________________
Dates from _____________________________ to
_______________________________________
□ Full-time □ Part-time □ Other, please specify ______________________
Responsibilities
__________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Accomplishments
_________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Reason for leaving
________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
II. Employer _________________________________ Job Title __________________________
Address
________________________________________________________________________
City _______________________________________ Country ___________________________
Dates from ____________________________ to
________________________________________
□ Full-time □ Part-time □ Other, please specify ______________________
Responsibilities
__________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Accomplishments
_________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Reason for leaving
________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
III. Employer ________________________________ Job Title ___________________________
Address
________________________________________________________________________
City _______________________________________ Country ___________________________
Dates from ____________________________ to
______________________________________
□ Full-time □ Part-time □ Other, please specify ______________________
Responsibilities
__________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Accomplishments
_________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Reason for leaving
________________________________________________________________
________________________________________________________________________________
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ACTIVITIES AND AWARDS
List your community and extracurricular collegiate activities in the
order of their importance to you.
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Activity
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Dates
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Office held, if any
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Time required
per week
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List any awards, honors, certifications or other forms of
recognition (academic, community, military, etc.) you have received.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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ESSAYS
Please complete the required essay, then choose and respond to two
additional questions from the numbered essay options. Double-space your
responses and use a minimum font size of 10. Please limit your answers to the
designated number of words. Please clearly label each essay.
Required Essays
1. Describe your
short-term and long-term career goals and explain how your past experience
together with your postgraduate study will contribute to your achieving them.
(750 words maximum)
2. Answer any 2 questions from the 4 choices below:
a. Describe a time when you were part of a
team in a professional environment that worked well. Also, describe a time when
you were part of a team that did not work well. (500 words maximum)
b. Reflect on a time
when your efforts resulted in a change within an organization. Please discuss
your role in these changes. (500 words)
c. Describe a situation where you were able
to use your leadership skills to create a better outcome. (500words)
d. Discuss a risk you
took that proved to be successful. Also describe a time when a risk you took
was not successful. (500 words)
Optional Essay
Please include any other information that you believe would be
helpful to the Admissions Committee in considering your application. (250 word
maximum)
DECLARATION
I certify that the information which I have provided on this
application is complete and correct, and that the essays have been written by
me. I understand that any misrepresentation or omission may be caused for
denying admission or permission to register at any time. I agree to abide by
all rules and regulations that are now, or may in the future be, in force at
the University. I understand that Westbrook University reserves the right to
deny admission or permission to register anyone whom it considers not qualified
and to require withdrawal of any student at any time for any reason it
considers sufficient, including scholarship, character, and personal conduct. I
understand that any items submitted in conjunction with this application become
the sole property of the POSTGRADUATE Program and will not be returned.
______________________________________________________________________________
Signature Date
Westbrook
University – POSTGRADUATE Program
RECOMMENDATION FORM
TO THE APPLICANT
Please type or print your name _____________________________________________________________________________
LAST FIRST
MIDDLE
Please give this form to the person who is to complete this letter
of recommendation. Please ask your recommender to place the complete form in an
envelope, seal the envelope, sign across the seal and return it to you. It may
be helpful for you to indicate to this person the timeframe for completion;
this unopened envelope must be included in the complete application package in
order for you to be considered for admission. This letter of recommendation
will not become a part of your permanent record.
I agree to waive
access to the letter of recommendation written by: __________________________
Name of recommender
Signature of applicant:__________________________________
Date:______________________
TO THE RECOMMENDER
The person named above is applying for admission to Westbrook
University’s International MBA Program. The Admissions Committee places a great
deal of importance on the statements made by recommenders. Your specific comments
on the applicant’s attributes and abilities provide the committee with a
balanced view from which to evaluate the candidate. We realize this requires
considerable time and effort on your part, and we greatly appreciate your
contribution to our admission process.
It is also acceptable to complete this recommendation in letter
format. In that case, we ask that you fill out the biographical information
below and staple the letter to this form. Please place the complete recommendation
in the envelope addressed to the candidate, seal the envelope, and sign your
name across the seal. This recommendation must be included in the complete
application package in order for the applicant’s file to be reviewed.
This recommendation will be used only for admission purposes only.
This form will not become part of the applicant’s permanent file, and the
applicant will not have access to this or any recommendation written on his or
her behalf.
Name of Recommender
____________________________________________________________
Title and Firm ____________________________________________________________________
Address
________________________________________________________________________
How long have you known the applicant? In what context? How often
do you interact? _________
________________________________________________________________________________
What are the applicant’s greatest strengths?
____________________________________________
________________________________________________________________________________
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Discuss areas where the applicant could improve.
_______________________________________
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Comment on the applicant’s leadership abilities and interpersonal
skills. _____________________
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Comment on personal motivation and initiative of the applicant.
____________________________
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________________________________________________________________________________
Using the chart below, please rate the applicant relative to other
employees whom you have known in a similar capacity.
OUTSTANDING
EXCELLENT GOOD AVERAGE WEAK
UNABLE
(TOP
2%) (TOP 10%) (TOP 25%) (TOP 50%) (LOWER 50%) TO RATE
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Leadership Potential
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Maturity
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Motivation and Initiative
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Analytical Skills
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Intellectual Ability
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Creativity
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Ability to Work Well with Others
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Oral Communication Skills
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Written Communication Skills
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Time Management Skills
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Personal integrity
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Sense of Humor
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Overall rating of the candidate
_______________________________________________________
Please comment on the ratings above. Feel free to make additional
comments about the applicant’s accomplishments, managerial potential and other
personal qualities.
_______________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________
May we contact you if our Admissions Committee believes it would
be helpful to speak with you regarding the applicant? □ Yes □ No
If yes, please provide your email address and daytime telephone
number.
Email Daytime Phone
Signature
_________________________________________Date ____________________
ADDRESS LABEL:
Only for International Applicants
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Name:
Address:
Phone: ___________________________
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