MBA application by Yr6TT4a

VIEWS: 20 PAGES: 11

									Name:
              Last                                                    First                                                Middle
Name you prefer to be called:

Social Security Number (if applicable):

Mailing Address:
                         Number and Street                                                           City                            State   Zip

Note: Phone number should be complete to include area code.

Home Telephone:                                                                       Email:

Permanent phone: ______________________________
(if different from home number)


Work phone: ______________________________                                            FAX: ______________________________


(List work phone only if it is OK to contact you at work; also, by providing an email address you authorize us to use this address
to communicate with you regarding all matters related to your application, including notification of an admission decision.)

Please check one box to indicate the program for which you applying and provide the year:

    Two-Year MBA Program beginning Fall, 200__

    11-Month MBA Program beginning Summer, 200__

    Evening MBA Program beginning Spring, 200__                        Summer, 200__           Fall, 200__

    I am applying for the joint MBA/JD Program. I plan to enroll in the MBA Program in Fall, 200__.
             I am currently enrolled in the University of Georgia Law School.

GMAT                                                    TOEFL (if non-US citizen, contact MBA office to determine if required)
Date taken/to be taken                                  Date taken/to be taken


Total Score                                             Total Score

                          OPTIONAL QUESTIONS – FOR INFORMATIONAL PURPOSES
How did you learn about the Terry MBA Program?

To what other MBA programs are you applying?

In what specializations/functional areas are you most interested? (Response will not impact application review positively
or negatively.

                                                        FOR OFFICE USE ONLY
02-03 (Fulltime - WORD)
DCDT:                                        DLH                    PCA                   YND                    TLW
DCDT:                                        DLH                    PCA                   YND                    TLW
ADCM:
1. FULL-TIME EMPLOYMENT HISTORY                             5. FOREIGN LANGUAGE PROFICIENCY
                                                            List all languages, other than your native language, with
Beginning with your most recent position, list each full-
                                                            which you are familiar. Identify your proficiency using
time employment position separately. In addition to
                                                            a 1-10 scale with 1-poor and 10-excellent. Identify if
completing this section, please include a current
                                                            you have used the language in a non-academic
resume. Upon completion of this section, please
                                                            (practical) setting.
explain any lapses in time between positions.
                                                            Language:
Employer:                                                   Proficiency:      Speaking      Reading     Writing
Nature of Employer's Business:
                                                            Number of years of study:
Employer's Location (city & state):
Dates of Employment (month/year - month/year):
                                                            6. PERSONAL ESSAYS
Total Number of Months Employed:
Your Position/Job Title:
                                                            Each response should be as complete as possible while
Description of Responsibilities:
                                                            also being concise.
Annual Salary: Starting -       Ending or Current -
Reason for leaving (if applicable):                         1. Why have you decided to pursue an MBA at this time?
                                                            In particular, why are you seeking admission to Terry?
                                                            Please describe the post-MBA position that would be ideal
2.     INTERNSHIP/ CO-OP, SUMMER, AND                       for you, and the personal attributes and experiences (to
                                                            include professional experiences) that make you a match
OTHER PART-TIME EMPLOYMENT HISTORY
                                                            for this position. (2 - 1/2 page limit)
(This section required only if full-time employment is
less than five years.)                                      2. Describe the most significant position of leadership you
                                                            have held to date. How did it expose skills/attributes you
Beginning with your most recent position, list              would consider strengths and those that need further
employment that falls under the above heading. Indicate     development? (2 page limit)
which type (i.e., internship, co-op, summer, part-time,
etc.) under the inquiry “Type of Employment”. At the        3. Please share with the admissions committee any unique
end of this section, total the number of months of part-    events, life experiences and qualifications that you feel
                                                            distinguish your candidacy and that will add value to the
time employment in this section.
                                                            class and enhance your success as a manager.
                                                            (1 - 1/2 page limit)
Employer:
Employer's Location (city & state):                         4. Optional: What would you like to tell us that we
Dates of Employment (month/year - month/year):              haven’t asked? Tell your MBA classmates who you are;
Type of Employment:                                         feel free to use words, illustrations, etc. to provide an
Responsibilities:                                           accurate description. (1 - 1/2 page limit)
Hours worked per week:

3. EXTRACURRICULAR COLLEGIATE,
PROFESSIONAL, AND COMMUNITY
ACTIVITIES
List in order of importance to you.

Activity:
Office/Position Held:
Dates of Participation:

4. DISTINCTIONS, HONORS, AWARDS and
OTHER RECOGNITION OF ACHIEVEMENT
(since secondary school)
List in order of importance to you. Include the date of
recognition and, where applicable, the basis for each
selection.
Name of Candidate:

Last                                                      First                                           Middle

Social Security Number:


To the Candidate:
Verify the information above. Any changes to the above need to be made on the “Candidate Information” page. Read the statement
that follows:
In accordance with the Family Educational Rights and Privacy Act of 1974, you may waive your right to inspect this
recommendation. Should you decide not to waive your right to access, you will have access to the recommendation if you are
admitted and enroll in the Terry MBA program at the University of Georgia. Please mark only one of the following statements and
place your signature in the space provided.

                 Confidential file.       I hereby waive my right of access to this recommendation.
                 Open file.               I retain the right of inspection of this letter upon enrollment in the Terry MBA program at
                                          the University of Georgia.


Candidate’s Signature:                                                            Date:



To the Recommender:
The person named above is applying for admission to the Terry MBA program at the University of Georgia. Your candid evaluation
of the candidate is an important part of the admission review. Please complete the information requested on both sides of this form.
If you need additional sheets of paper, please staple them to the back of this form. This recommendation will remain confidential
during the admission process. Please note that while the candidate may have waived his or her right of access under the Family
Educational Rights and Privacy Act, in some circumstances this letter may be subject to disclosure under the provisions of the
Georgia Open Records Act. Please type or print your responses to each question. We appreciate your time and thank you for your
assistance.

Recommender’s name:                                                           Date:
                            (type or print)




Position/Title                                                    Company or Institution


Address:


City, State, Zip:




1.   How long have you known the candidate?



2.   Please discuss what you consider to be the candidate’s strengths.




3.   Please discuss areas the candidate needs improvement. What efforts has the candidate made to improve in these areas?
4. Please evaluate the candidate by category referencing other MBA candidates you have known and/or individuals you consider
to be successful professionals.


                           Outstanding           Good           Above Average         Average       Below Average         Unable to
                             90-100%            75-89%              60-74%            40-59%             <40%              Judge


Intellect


Quantitative skills


Verbal Expression*


Written Expression


Maturity


Creativity/Imagination

Ability to work
with/get along with
others

Leadership potential

*For individuals whose native language is not English, the verbal expression evaluation should include their English proficiency.


5. On a scale of 1-10, with 1 being extremely introverted, and 10 being extremely extroverted, where would you place the
candidate?




6. Please comment on personal qualities of the candidate, such as sense of humor, integrity, self-confidence, etc.




7. Please provide any additional information you feel will aid the selection committee in evaluation of the candidate. Comments
regarding the candidate’s potential for graduate business study and potential for professional and career advancement will be most
helpful.




8. Please check the box reflecting your recommendation of the candidate on the basis of his or her qualifications and potential to
carry on advanced study and his or her promise of professional success.
          Strongly recommend            Recommend           Recommend with reservations            Do not recommend




Recommender’s signature:                                                                 Date:


Instructions for Returning Recommendation:
Please place this recommendation in the envelope addressed to the candidate, seal the envelope, and sign across the seal. Return it
to the candidate as soon as possible. The candidate will submit the sealed envelope containing your recommendation as part of their
application package. Your prompt response in returning this form to the candidate will help complete the application in a timely
manner.

Thank you again for your assistance!
                        A CULTURE OF HONESTY AT THE UNIVERSITY OF GEORGIA
                                             Preamble
  The University of Georgia seeks to promote and ensure academic honesty and personal integrity among students and
other members of the University community. A policy on academic honesty (and procedural guidelines to adjudicate
violations of academic honesty) has been developed to serve these goals. Academic honesty is defined broadly and
simply — the performance of all academic work without cheating, lying, stealing, or receiving assistance from any other
person or using any source of information not appropriately authorized or attributed.
   Academic honesty is vital to the very fabric and integrity of the University of Georgia. All students must comply with
an appropriate and sound academic honesty policy and code of honest behavior. All members of the University
community are responsible for and involved in bringing about an honest university, and all must work together to ensure
the success of the policy and code of behavior.
   All members of the academic community are responsible for knowing the policy and procedures on academic honesty.
The statement on policy and procedures will be furnished to all students and faculty to ensure understanding of the
academic honesty system and its proper functioning.
   Students and faculty together operate the academic honesty system. Where suspected violations of academic honesty
occur, appropriate procedures are designed to protect the academic process and integrity while ensuring, as much as
possible, the ideals of due process rights. The academic honesty system is an academic process, not a court of law.

Prohibited Conduct
Part 1: No student shall knowingly perform, attempt to perform or assist another in performing any act of academic
dishonesty.
Part 2: The following acts by a student are examples of behavior constituting academic dishonesty:
   a. Plagiarism - This means submitting for academic advancement the words, ideas, opinions or theories of another
which are not common knowledge, without fair attribution to that other person. Unfair attribution includes, but is not
limited to a direct quotation of all or part of another’s words without identifying that fact by appropriate marks, and/or
merely stating the source generally in a bibliography without having noted the specified sources within the body of the
work.
   b. Unauthorized assistance - Giving or receiving assistance in connection with any examination or other academic
work which has not been authorized by a faculty member. During examinations, quizzes, lab work and similar activity,
students are to assume that any assistance (such as books, notes, calculators and conversations with others) is
unauthorized unless it has been specifically authorized by a faculty member.
   c. Lying/Tampering - Giving any false information in connection with the performance of any academic work or in
connection with any proceeding under this policy.
   d. Theft - Stealing, taking or procuring in any other unauthorized manner (such as by physical removal from a
professor’s office or unauthorized inspection of computerized material) information related to any academic work (such
as exams, grade records, forms used in grading, books, papers, computer equipment and data, and laboratory materials
and data).
   e. Failure by a student to comply with a duty imposed under Section 6 of this policy (see web site identified below).

Any behavior which constitutes academic dishonesty is prohibited even if it is not specifically listed in the list of
examples that can be found at the web site identified in the next paragraph.

I have read, understand, and agree to abide by the University of Georgia's academic policy as stated above and on the
web page of the Senior Vice President for Academic Affairs and Provost (www.uga.edu/~vpaa). I also understand that I
can receive a paper copy by calling 706-542-0432. In addition, I certify that all the information provided by me in
support of my application is my own and is complete and accurate to the best of my knowledge.

Print Name:

Signature:                                                                          Date:

***Please sign, date and return this form with your application materials. Thank you.




TCB Self-completing-GW02-03 (Word)
                                         Be sure to complete next page
                                                                              The University of Georgia
                                                                   Office of Graduate Admissions, Graduate School
                                                                               Athens, GA 30602-7402
All information should be complete and clearly stated. Do not use the “Fee” or “NRGZ” boxes. Please enclose the $62.00
application-processing fee with your application. Applications submitted without the fee will not be processed.

                                                                        APPLICANT INFORMATION                                                                     Fee

1.     Social Security Number/ID Number                                             2. Date of Birth (M/D/YYYY)              3. Date Submitted


       If you do not have a U.S. social security number, leave
       blank. An identification number will be assigned to you.


4. Name:
                     Last/Family Surname                                           First                            Middle                 Jr., III, Etc.


5. Day Phone Number:                                                               Email Address:

                                                                                   FAX number:

Indicate other names used on official records if different than above:


6. Address

Street and Number

City                                                              State/Province       Zip/Postal Code                Telephone Number

Country of Address (if not USA)
(For items 7, 8, 9 and 10, please mark only one check box.)
7. Ethnic Origin*                                                      9. Residency Status
NATIVE AMERICAN (I)                                                    LEGAL RESIDENT OF GEORGIA?
AFRICAN AMERICAN (B)                                                   YES (R)       NO (N)       IF YES, which Georgia county?
HISPANIC (H)                                                           Also, if YES, you must complete the Application For Georgia
ASIAN OR PACIFIC ISLANDER (A)                                          Residence Status form and return it with this application.
WHITE (Non-Hispanic Origin) (W)                                        IF NO, state of legal residence:
MULTIRACIAL (M)
                                                                       10. Citizen Status Code
8. Sex*                                                                Born U.S. CITIZEN (C)            NATURALIZED U.S. CITIZEN(N)
MALE (M)                 FEMALE (F)                                    ALIEN, RESIDENT (R)     (If resident alien, attach copy of resident alien card)
                                                                       ALIEN, NON-RESIDENT (A)         (If presently in the U.S., indicate the type of visa you
*Provision of information requested regarding
ethnic origin and gender is optional. Such                             have:
information is gathered for purposes of
compliance with state and federal reporting                            11. Country of citizenship (if not USA):
requirements only. Neither provision of the
requested information nor failure to provide such
information will adversely influence admission to a                    12. Place of birth (if not USA):
UGA Graduate program.                                                                                      (City, State, Country)
                                                                                                                                                                   NRGZ
                                                                    ADMISSION INFORMATION


1. SEMESTER YOU PLAN TO ENTER:                                             FALL (08)            SPRING (02)          SUMMER (05)                  20
       (mark one box and indicate year)

2. APPLICATION TYPE:                              ADMISSION                READMISSION If readmission, date previously applied:

3. DEGREE OBJECTIVE:                         MBA           MAJOR                    BUSINESS ADMINISTRATION

4. DEGREE MAJOR CODE: 121A

5. I HAVE TAKEN OR WILL TAKE THE                                        GMAT ON THE FOLLOWING DATE:


TCB Self-completing-GW02-03 (Word)
                                                                  Be sure to complete next page
                                                        PREVIOUS EDUCATIONAL EXPERIENCE

    List all institutions of higher education previously attended or currently attending (attach separate sheet if additional space is
    needed). Refer to page 3 for complete details on transcript requirements. Complete disclosure is required of all applicants.
    Include any previous University of Georgia attendance; however, University of Georgia transcripts are not required.

                                                                                       ATTENDANCE
                                                            LOCATION                  (MONTH, YEAR)               GRADUATION           DEGREE OBTAINED/ TO
            COMPLETE SCHOOL NAME
                                                          (CITY, STATE)                                              DATE                 BE OBTAINED
                                                                                     From              To




                                                                  WORK EXPERIENCE

List present or other work experience beginning with most recent position:

        DATES                                                                                PLACE
                                         ORGANIZATION                                                                                    POSITION
  (MM/YYYY – MM/YYYY)                                                                    (CITY, STATE)
           -
           -
           -
           -

                                                               EMERGENCY CONTACT


 Name:
               Last/Family Surname                            First                                  Middle                         Jr., III, Etc.

               Relationship To You:                 Parent                 Spouse                 Guardian              Other

 Contacts Address:
 (or check if same Street and Number
 as yours)

                        City                                                     State/Province       Zip/Postal Code


                        Telephone Number                                         Country of Address (if not USA)




               CERTIFICATION STATEMENT AND HONOR CODE - ALL APPLICANTS
               "I will be academically honest in all my academic work and will not tolerate academic dishonesty of others." I understand that by
               signing this Application for Graduate Admission, I am subscribing to the above Honor Code. I further attest that all the information I
               have supplied on this form is true to the best of my knowledge, that any omission or misrepresentation may invalidate further
               consideration, and that I have an obligation to update the information submitted to the University until I enroll.

               Signature_________________________________________________________ Date:




                                                                                                                                              (Word)
                              APPLICATION FOR GEORGIA RESIDENCE STATUS
This form must be completed if you are claiming permanent legal residence in the State of Georgia for the purpose of
paying in-state fees. All questions must be answered. Section A must be completed by the applicant. Section B of this
form must be completed by the parent or legal guardian if the applicant is a dependent. Supporting documents and
additional information may be requested. The completed form must be returned with your application for admission.

SECTION A — APPLICANT

1. Social Security Number:                                            2. Birth date:
                                                                                             MONTH/DAY/YEAR
3. Name of Applicant:
                           Last                                      First                              Middle
4. Citizenship           U.S.     Non-U.S.         If Non-U.S., specify Visa or Green Card No.

5. How long have you lived in Georgia:

6. Where have you lived (in the sense of physical presence) in the last two years? List current address first.

   From             To                                                                                                   Zip Code
                                           Street Address                              City                   State
 (MM/YYYY)       (MM/YYYY)




7. Employment Information (for at least one year prior to the date for which in-state tuition rates are sought):
    From         To
                                           Employer                                     City                     State   Hours/Week
 (MM/YYYY)       (MM/YYYY)




                                                                                                      Yes        No
8. Do your parents or legal guardian provide over half of your financial support or claim
you as a tax dependent?

9. Will you have filed a tax return or paid income taxes to any state other than Georgia
during the past year? If YES, explain.

10. For at least one year immediately prior to the term in which you will enroll, will you have
           a. filed a tax return or paid income taxes to Georgia on all earned income?
           b. been a registered voter in Georgia? Date registered:
           c. held a valid Georgia driver’s license? Date issued:

11. Do you own or operate a motor vehicle?
         If YES, has it been registered in any state other than Georgia during the past year?

12. Are you or any member of your immediate family presently in the military?
If NO, go to question 13a.
If YES, check:         Self             Spouse              Parent/Guardian

          a. Are Georgia income taxes paid on all military income? If yes, please submit
          recent copy of Leave and Earnings Statement reflecting Georgia withholding.

          b. If your spouse is in the military, and the answer to (a) is NO, will you have
          resided in Georgia, been employed, and paid income taxes to Georgia for at
          least one year immediately prior to the term in which the applicant will enroll?

          Please indicate date military member was stationed or established residence in
          Georgia pursuant to military orders:
          Attach copy of orders.
13a. Are you currently attending an institution of higher learning outside the State of Georgia?
If YES, proceed to 13b.

13b. Does the institution charge out-of-state fees?

If YES, have the institution's Registrar verify by letter that you are paying out-of-state fees.

I certify under penalty of disciplinary action that the information I have provided is true.


Signature of Applicant                                                                                 Date



                                   SECTION B — PARENT OR LEGAL GUARDIAN

1.    Name of Parent or Legal Guardian:

2.    Relationship to Applicant:

3.    Citizenship        U.S.       Non-U.S. If Non-U.S., specify Visa or Green Card No.

4.    How long have you lived in Georgia?                         Daytime Telephone

5.    Where have you lived (in the sense of physical presence) in the last two years? List current address first.

     From           To
                                              Street Address                           City                 State
 (MM/YYYY)       (MM/YYYY)                                                                                                Zip Code




6.    Employment Information (for at least one year prior to the date for which in-state tuition rates are sought):

     From           To
                                                Employer                               City                 State         Hours/Week
 (MM/YYYY)       (MM/YYYY)




                                                                                                                    Yes
         No
7. Will you have filed a tax return or paid income taxes to any state other than Georgia

     during the past year? If YES, explain.

8. Will you have claimed the applicant as a dependent on your federal and Georgia income tax

      return the year prior to the term in which the applicant will enroll?

9. Will you have provided over half of the applicant’s financial support for at least one year prior to the

     term in which the applicant will enroll?

10. For at least one year immediately prior to the term in which the applicant will enroll, will you have
           a. filed a tax return or paid income taxes to Georgia on all earned income?

            b. been a registered voter in Georgia? Date registered:
          c. held a valid Georgia driver’s license? Date issued:


11. Do you own or operate a motor vehicle?

          If YES, has it been registered in any state other than Georgia during the past year?


12. Are you or your spouse in the military?

If NO, proceed to the date field below.
If YES, check:         Self                   Spouse

a. Are Georgia income taxes paid on all military income? If YES, please submit a recent copy of
                   Leave and Earnings Statement reflecting Georgia withholding.

b. If the answer to (a) is NO, will the applicant’s non-military parent have resided in Georgia,

paid Georgia income taxes and claimed the applicant as a dependent for federal and Georgia
income tax purposes for at least one year immediately prior to the term in which the applicant
will enroll? If YES, please submit verification of employment, including dates and salary,
and a copy of the most recent Georgia tax return.

If the answer to (a) and (b) are NO, indicate date military member was stationed or established
residence in Georgia pursuant to military orders:
Attach copy of orders or other military-acknowledged document.

I certify that the information I have provided is true.


Signature of Parent of Legal Guardian                                                              Date

								
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