Kellogg-Schulich EMBA Application Step 1 of 12 0% Welcome to the Kellogg-Schulich Executive MBA Application form. You will be completing the form in a series of steps, which will be reflected in the progress bar above each section. You can stop at any time and return to your form by clicking on the "Save and Continue Later" button. You would then receive a message prompting you to enter your email address to receive the link, which would allow you to resume completing the form at a later time. At the end of the form, you will see a link that will take you to a secure site to pay the application fee. Should you have any questions or encounter any difficulties, please contact us at emba@schulich.yorku.ca or (416) 736-5486. Personal InformationPrefix- please select -Mr.Mrs.MissMs.Dr.Gender- please select -FemaleMaleLast Name* First Name* Middle Name Preferred First Name Previous Last Name (if applicable) Email* Date of Birth Month Day Year Current Mailing AddressAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business AddressCompany Name Your Position Address Same as previous Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneExtension Fax Current Citizenship and Immigration StatusCountry of Birth Date of Entry into Canada Month Day Year Country of Citizenship Citizenship Canadian citizenship Dual citizenship Landed immigrant Other Please Specify LanguagesList the languages other than English in which you have a working ability. Indicate your level of proficiency (excellent, good, fair).List the languages other than English in which you have a working ability. Indicate your level of proficiency (excellent, good, fair).LanguageUnderstandSpeakReadWrite - proficiency -excellentgoodfair - proficiency -excellentgoodfair - proficiency -excellentgoodfair - proficiency -excellentgoodfair Mother Tongue English French Other Please Specify Employment HistoryLast three positions heldPeriod (start and end dates)EmployerPosition Total amount of full-time post-baccalaureate work experience, including military experience, as of the date admission is sought:Years Months Professional QualificationsDateInstitution or AssociationDesignation/Certificate Academic InformationUniversity or CollegeCountryFrom month/yearTo month/yearDegree received or expected If you are working toward a degree, indicate when it will be completed.Month Year Have you previously applied to a graduate program at York University? Yes No If yes, what year? Have you previously applied to the Schulich School of Business? Yes No If yes, what year? Information on Degrees, Industry and Management ExpertiseTo be used to form EMBA study groupsMajor area of study of last degree program attended. (check all that apply and specify concentration in field below) Art, Media, Performance Business or Commerce Engineering Environmental Health Law Liberal Arts Science Others Specify concentration from aboveCurrent Industry Basic Materials - Nonferrous Metals Basic Materials - Coal Basic Materials - Specialty Chemicals Basic Materials - General Mining Basic Materials - Paper Consumer Goods - Clothing & Accessories Consumer Goods - Personal Products Consumer Goods - Food Products Consumer Goods - Tobacco Consumer Goods - Brewers Consumer Services - Media Agencies Consumer Services - Broadcasting & Entertainment Consumer Services - Retailers & Wholesalers Financial Services - Insurance Financial Services - Banks Financial Services - Real Estate Services Financial Services - Consumer Finance Health Care - Biotechnology Health Care - Medical Equipment Health Care - Pharmaceuticals Health Care - Health Care Provider Industrial - Heavy Construction Industrial - Marine Transportation Industrial - Aerospace Industrial - Commercial Vehicles Non-Profit/Public Sector Oil & Gas - Oil Equipment & Services Oil & Gas - Exploration & Production Oil & Gas - Pipeline Oil & Gas - Renewable Energy Technology & Telecommunications - Software Technology & Telecommunications - Internet Technology & Telecommunications - Computer Services Technology & Telecommunications - Electronic Office Equipment Technology & Telecommunications - Semiconductors Technology & Telecommunications - Mobile Utilities - Water Utilities - Alternative Electricity Utilities - Gas Distribution Utilities - Conventional Electricity Other Please Specify Please assess your proficiency in each of the following areas of management.Accounting Low Moderate High Marketing Low Moderate High Finance Low Moderate High Operations Low Moderate High Quantitative skills Low Moderate High General Management/Policy Formulation Low Moderate High Source of EMBA InformationHow did you FIRST learn about the Kellogg-Schulich Executive MBA Program?(Check all boxes that apply.) Kellogg/Schulich alumni Kellogg/Schulich students Website Consultation with EMBA Program staff EMBA Program brochure University/Career MBA fairs Article in the media Business school rankings EMBA print advertisement EMBA radio advertisement EMBA Web advertisement Other Please specify Essay QuestionsPlease answer each of the following questions limiting to 500 words per essay.1. Please outline your career strategy and objectives and how you hope to apply the knowledge gained from the Kellogg-Schulich Executive MBA Program to achieve them.2. Describe a situation at work that best illustrates how your direct contribution has had a strategic and/or lasting impact on your organization.3. Describe a professional situation that turned out unsuccessfully. How did you resolve it? What did you learn from it? DeclarationAgreement* It is understood that during my participation in the program, I will be free of other duties on class days and will not be absent for any reason other than an emergency or extenuating circumstances. I am aware of the time commitment to complete the program, particularly the time required to travel to locations other than the site of the Schulich School in order to attend classes. I agree to be free of other duties in order to attend these required classes. I understand that it is my responsibility to obtain the necessary travel documents and information that will allow me to enter Canada to study (where applicable) and to travel to other countries in order to complete the requirements of the Kellogg-Schulich Executive MBA Program. I also understand that any cost associated with obtaining the requisite travel documents and information will be my own responsibility. Further, I understand that I may be required to provide this information to support my application to the Kellogg-Schulich Executive MBA Program. I hereby certify that all statements on this application are correct and complete, including my declaration of citizenship and status in Canada. I understand that I may have to provide documentation at some future date to substantiate my claim and that any misrepresentation of this data may result in the cancellation of my admission to or registration status in the Kellogg-Schulich Executive MBA Program. Print your full name* Date* Month Day Year NameThis field is for validation purposes and should be left unchanged.