Social Security Number Gender Birth Date
Last Name First Middle Preferred First Name
Permanent Address City State Zip Code
Home Phone Work Phone Emergency Phone Email Address
Race/Ethnic Identification (required for federal reporting)
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Black, Non-Hispanic
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Hispanic
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White, Non-Hispanic
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Asian, Pacific Islander
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American Indian/Alaskan
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Parish of Residence State of Residence US Citizen (yes or no) Citizenship (if not US)
Academic Information
List the last high school attended and year of graduation
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High-school Year of graduation
List chronologically all colleges previously attended (including SLU), beginning with the college most recently attended.
Name of Institution
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Dates attended (Month/Year)
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Degree(s) Earned
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Hours Earned
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From
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To
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Undergraduate Degree GPA (estimate) TOEFL Score (if applicable)
GMAT Score (if available) Date GMAT taken or anticipated test date
EMBA Program Application for Admission – page 2
Business Information
Present Employer Beginning Date Immediate Supervisor (including title)
Last Name First Middle Preferred First Name
Business Address City State Zip Code
Telephone Extension Fax
Your Present Title Beginning Date at Current Title
Description of duties and responsibilities:
Description of products or services furnished by your organization:
Number of people you directly supervise: Current annual salary (optional):
Professional Certifications:
How many years of full-time business experience (including military) have you had?
Previous employment record (include previous positions with present employer). You may use an additional sheet if necessary, or attach a resume.
Company
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Dates Employed
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Positions held (beginning with current)
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From
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To
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Military Record, if applicable:
EMBA Program Application for Admission – page 3
Academic and Professional Enhancement
If you have pursued any other significant non-degree academic or professional programs, please list below.
Course/Enhancement Title
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Dates attended
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Location
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Sponsor/School
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List any major reports, articles, manuals, or projects that you have prepared, researched, or published:
List any community and professional activities that you have completed:
Applicant’s Agreement
If admitted to the Executive MBA program, I agree to follow the program regulations established by Southeastern Louisiana University, the Graduate School, and the College of Business. I also agree to assume responsibility for assuring that tuition and fees are paid in a timely manner.
Signature of Applicant Date
Statement of Recognition of Participation
College of Business
Executive MBA Program
SLU 10735 Hammond, LA 70402
Phone (985) 549-2146 Fax (985) 549-3977
emba@selu.edu
www.selu.edu/Academics/Business/emba/
We believe it is important for employers to recognize the commitment and dedication necessary for a student to successfully complete Southeastern Louisiana University’s Executive MBA Program. Our estimate of the average time needed by students to meet program demands is 20 hours per week, including class time and preparation time.
Your signature indicates that you are aware of the applicant’s intent to participate in our program. Completion of this form does not constitute a letter of reference on behalf of the candidate.
Applicant’s Name
Name of Company
Employer’s Name (please print or type)
Employer’s Title
Employer’s Signature Date
Transcript Request Form
College of Business
Executive MBA Program
SLU 10735 Hammond, LA 70402
Phone (985) 549-2146 Fax (985) 549-3977
emba@selu.edu
www.selu.edu/Academics/Business/emba/
Transcript Request Form For EMBA Students
TO THE APPLICANT: Please
type or print, include appropriate fee (if any) and mail directly to the institution from which you are requesting your transcript.
Full Name:
Last First Middle/Former
Social Security or University ID Number:
College/University/Campus:
Dates of attendance:
Degree and year:
N
umber of copies of transcript requested:
I authorize release of the official transcript of my academic record at the institution named above for submission to the Southeastern Louisiana University EMBA program.
Signature Date
TO THE REGISTRAR: This person is applying for the admission to the
EMBA Program of Southeastern Louisiana University. Please forward the requested transcript (s) to:
Executive MBA Program
SLU 10735
Hammond, LA 70402