Women Directors Leadership Programme Application Form

Women Directors Leadership Programme - Application Form

Step 1 of 5

Date of Application*
DD slash MM slash YYYY
PART A: PERSONAL INFORMATION PLEASE COMPLETE IN BLOCK CAPITALS
Mr. Mrs. Ms. Dr. Official name (s)*
Preferred name (for the badge)*
Date of Birth*
DD slash MM slash YYYY
Postal work address*
Postal code*
Country*
Town*
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:

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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
Name of Organization
Current Title
Address
City
Postal Address
Country
Phone*
Mobile Phone
Fax (Office)
Email (Office)*
Hidden
Company Web Address
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
Name of Organisation
Current Title
Address
City
Postal Code
Country
Phone
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

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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
Director Experience
Please fill out names of bards and organizations that you served in, the duration of service and the role you play(ed) e.g. Secretary, Chair, Member etc
Name of Board/ Organisation*
Years Served*
Role (Member, Secretary, Chair e.t.c)*
Name of Board/ Organisation
Years Served
Role (Member, Secretary, Chair e.t.c)
Name of Board/ Organisation
Years Served
Role (Member, Secretary, Chair e.t.c)
Name of Board/ Organisation
Years Served
Role (Member, Secretary, Chair e.t.c)
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 programs? 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
Leadership Challenges and Lessons
Please fill out some leadership challenges you have faced at Director level and lessons learnt from the challenges.
*

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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*
Mobile Phone*
Date*
MM slash DD slash YYYY
Company Website Address
Hidden
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

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Women Directors Leadership Programme Application Form

Women Directors Leadership Programme - Application Form

Step 1 of 5

PART A: PERSONAL INFORMATION PLEASE COMPLETE IN BLOCK CAPITALS

PART B: CURRENT POSITIONS

ORGANISATION 1

ORGANISATION 2

Professional Experience

Director Experience

Complementary Informantion

Leadership Challenges and Lessons

Attach profile

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 program

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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