Global CEO - Africa Programme Application Form - Strathmore University Business School

Global CEO - Africa Programme Application Form

Step 1 of 4

Date of Application*
DD slash MM slash YYYY
PART A: PERSONAL INFORMATION PLEASE COMPLETE IN BLOCK CAPITALS
Title (Mr. Mrs. Ms. Dr. Prof, etc)*
Official name (s)*
Preferred name (for the badge)*
Date of Birth*
DD slash MM slash YYYY
Postal work address*
Postal code*
Country*
Town*
To which email address should we send the programme details?*
Official E-mail*
Phone*
Fax
Physical work address*
Personal Email*
Postal home address*
Personal Mobile Phone*
Personal Assistant/Secretary: Name
Personal Assistant/Secretary Email
Personal Assistant/Secretary Mobile Number:

PART B: CURRENT POSITIONS
Please detail your current responsibilities. If multiple, please indicate on point 1, the organisation to which you devote most of your time and use 2 detail the other one.
ORGANISATION 1
Industry
Name of Organization
Current Title
Address
City
Postal Address
Country
Phone
This field is hidden when viewing the form
Phone
Mobile Phone
Fax (Office)
Email (Office)*
Company Web Address
Main Field of Activity*
Annual Sales*
No. of Employees*
Asset(s) under your management*
Sales Managed
To whom you report*
No. of People Managed*
ORGANISATION 2
Industry
Name of Organisation
Current Title
Address
City
Postal Code
Country
Phone
This field is hidden when viewing the form
Phone
Mobile Phone
This field is hidden when viewing the form
Mobile Phone
Fax (Office)
Email (Office)
Company Web Address
Main field of activity
Annual sales
Number of employees
Asset(s) under your management
Sales managed
To whom you report
No. of people managed

PART C: EXPERIENCE WITHIN YOUR CURRENT COMPANY
Please list all full-time positions you have held since you joined the organisation 1 (listed in part B) starting with your current position
Date*
MM slash DD slash YYYY
Position*
No. of people managed*
Responsibilities*
Date
MM slash DD slash YYYY
Position
No. of people managed
Responsibilities
Date
MM slash DD slash YYYY
Position
No. of people managed
Responsibilities
Professional Experience
Starting with the most recent, please list three positions you have held in years before joining your present organisation. State your responsibilities in these positions.
Date
MM slash DD slash YYYY
Organisation
Title
Responsibilities & Duties
Date
MM slash DD slash YYYY
Organisation
Title
Responsibilities & Duties
Date
MM slash DD slash YYYY
Organisation
Title
Responsibilities & Duties
Complementary Informantion
Higher education (University or graduate school). Starting with the most recent, please complete the table below.
Institution
Location
Degree
Graduation Year
Institution
Location
Degree
Graduation Year
Institution
Location
Degree
Graduation Year
Have you attended any professional programmes? Starting with the most recent please complete the table below:
Institution
Location
Award
Graduation Year
Institution
Location
Award
Graduation Year
Institution
Location
Award
Graduation Year
On a scale of 1 - 10 please indicate in which of the following areas you feel you are most proficient (10 points) or at least (1 point).
Administration
Human Factor and Personnel
Marketing and Sales
Product & Operations
Information Systems
Finance
In what way do you think you can contribute to the education of your fellow participants in the program?
*
Please indicate where you learnt about the programme
*
- Alumnus of Strathmore
- Direct Mail
- Internet
- Advert. Please indicate Media
- Others
If others please specify
Do you have any dietary concerns that we consider? e.g. Diabetic, Vegetarian etc.

PART D: BILLING DETAILS
Payment is due upon notification of admission and indicate the details that should appear on the invoice for this application. To enable us process your application, it is important that you complete all the following information. Please make your payments to Strathmore Business School.
Name of participant*
Invoice to*
Person in charge of invoicing (if different form above)*
Billing address*
City*
Town*
Postal code*
Country*
Phone*
This field is hidden when viewing the form
Phone
Mobile Phone*
Mobile Phone
Date*
MM slash DD slash YYYY
Company Web Address*
Cancellation Policy
All cancellations must be made in writing. Cancellations made less than a month to the programme date are subject to a penalty of 25% of total programme fee
Date*
MM slash DD slash YYYY
Consent*
I agree to the privacy policy.
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Global CEO – Africa Programme Application Form

Global CEO - Africa Programme Application Form

Step 1 of 4

PART A: PERSONAL INFORMATION PLEASE COMPLETE IN BLOCK CAPITALS

PART B: CURRENT POSITIONS

ORGANISATION 1

ORGANISATION 2

PART C: EXPERIENCE WITHIN YOUR CURRENT COMPANY

Professional Experience

Complementary Informantion

On a scale of 1 - 10 please indicate in which of the following areas you feel you are most proficient (10 points) or at least (1 point).

In what way do you think you can contribute to the education of your fellow participants in the program?

Please indicate where you learnt about the programme

Do you have any dietary concerns that we consider? e.g. Diabetic, Vegetarian etc.

PART D: BILLING DETAILS

Cancellation Policy

A Culture of Ethics & Learning

SBS PARTNERS

Information For

Useful Links

Resources

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