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Executive MBA Application for Admission

Please remember to read the instructions before submitting your application. Some supplemental materials are required to be submitted via postal mail.




Program Information
Preferred Start Date:   Please make a selection.
Have you previously enrolled at UNH?

      Please make a selection.
If yes, please explain:
Have you previously applied for admission to UNH?

      Please make a selection.
If yes, please explain:

General Information
Social Security number (last four digits): ###/##/ (optional)
Last Name: Required.
First Name: Required.
Middle Initial:
   
Home Address: Required.
City: Required.
State: Required.
Postal Code: Required.
Country: Required.
Home Phone: Required.
Cell Phone:
Personal Email: Required.
   
Business Address:
City: Required.
State: Required.
Postal Code: Required.
Business Phone: Required.
Business Fax:
Business Email: Required.
   
Date of Birth: Required.
Place of Birth:
Preferred Email:      Please make a selection.
Preferred Phone:         Please make a selection.
Preferred Mailing Address:      Please make a selection.
Title:         
Citizenship:         Please make a selection.
If not U.S. Citizen, your Country of Citizenship:
Current Immigration status for Non-U.S. Citizen and non-green card holders:
Alien Registration #:

For U.S. Citizens Only To meet federal and state reporting requirements. The information is not used to determine eligibility for admission. This section is optional.
Ethnicity (Optional)
Gender:   
 

Work History
Employer Name: Required.
Division:
Current Job Title: Required.
Primary Employer Industry:
How long have you been with this company? Required.
Total numbr of years of professional work experience: Required.

Total numbr of years of managerial experience: Required.

Annual Salary:
Total number of people you supervise directly or through others:
Please describe your major responsibilities: Required.
Organizational Chart:
Please construct an organization chart indicating your position within the organization, including reporting relationships. Submit to address on instructions page.
Letter to Admission Committee:
Please write a letter to the Admission Committee giving the reasons you should be admitted. Please indicate what you hope to gain and what skills/experience you bring to this program. Submit to address on instructions page.
Decision-Making Responsibility:
Please check the extent of your decision-making responsibility, as it relates to your current position, within each of the categories listed below:
   
Policy Development

Required.
Budget Development Required.
Control of Budget expenditures Required.
Capital expenditures above 10K Required.
Hiring/dismissal of management, technical, and/or professional personnel Required.
Performance evaluation and compensation of management, technical, and /or professional personnel Required.
Interface with regulatory agencies Required.

Educational Information
In chronological order, please list all colleges, universities, graduate, and professional schools which you have attended:
(official transcripts are required for each undergraduate institution attended, including transfer credits)
Name of Institution: Required.
City: Required.
State: Required.
Dates Attended:
 Required.
Credits: Required.
Degrees Earned: Required.
   
Name of Institution:
City:
State:
Dates Attended:
Credits:
Degrees Earned:
   
Name of Institution:
City:
State:
Dates Attended:
Credits:
Degrees Earned:

Letters of Recomendation
Please list the two persons you have asked to write letters of recommendation:
 
Name: Required.
Title: Required.
Company: Required.
   
Name: Required.
Title: Required.
Company: Required.

Source Information
Please indicate how you learned of this program. (Check all that apply)
 
Referral: UNH EMBA Student or Alumnus
Non-EMBA UNH Student or Alumnus
HR Director, or other Manager in your Organization
Colleague

Newspaper (please specify):
Magazine (please specify):
Radio Station (please specify):

Web: Google
Yahoo
Bing
UNH website
MBA.com
Businessweek.com
Wall Street Journal online
Gradshools.com
LinkedIn
Other

Mail: Invitation/Announcement
Email
   

Billing:

If accepted, the fees for the Executive MBA Program will be paid:
  By the applicant
In full by applicant's sponsoring organization
By applicant with company reimbursement (please specify % being reimbursed):
      Please make a selection.
   

Signature:

By entering your name in the box, you are electronically signing your application and agreeing to abide by all policies and statements. The information supplied on this application is complete and true to the best of my knowledge. All materials and supporting records submitted by me or on my behalf in connection with this application or my attendance will not be released to anyone other than authorized university personnel without my consent.

It is understood that incorrect or falsified information will be grounds for disapproval of this application or dismissal from the university. The undersigned agrees to pay all financial obligations if admitted to and attending the university, including assessed collection costs and any obligations incurred if financial aid is terminated, reduced, or postponed for any reason. I agree to be governed by the academic standards, policies, rules and regulations of the University of New Haven, and to meet all financial obligations incurred by my attendance at UNH.

The undersigned also authorizes the Marketing and Enrollment Communications Department of the university to publish the applicant's picture, address, major, honors, sports, or other activities for public relations purposes should the applicant decide to attend the university in any capacity. This publicity authorization may be rescinded by notifying the Marketing and Enrollment Communications Department in writing within 30 calendar days of admission to the university. Information related to campus crime statistics and security measures is available upon request.

The University of New Haven is committed to equal access to educational and employment opportunities for all applicants regardless of race, creed, color, religion, gender, national or ethnic origin, age, sexual orientation, or disability in compliance with federal and state statutes. In order to receive accommodations for a disability, students with disabilities must initiate a request for services by calling the Director of Disability Accommodation Services at (203) 932-7331.

   
Applicant's Signature: Required.
Date: Required.
Successful submission of this form will take you to a secure page where you can submit your $75 application fee.

For additional questions or comments contact:

emba@newhaven.edu
Phone: 203-479-4206
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