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STANFORD ADVANCED PROJECT MANAGEMENT PROGRAM APPLICATION FORM Please complete all sections of the application in full. Only COMPLETE applications will be reviewed . General Information Please check one Mr. Ms. Mrs. Dr. (optional): Name: (First, Middle, Last) Company: Title: Company Address: (No P.O. boxes please – street address) City/State/Zip: Country: Business Telephone: Fax: Business Email: Personal Information Home Address: (No P.O. boxes please – street address) City/State/Zip: Country: Home Telephone: Personal Email: Preferred address Business Home for receiving course materials: Organization Information Company/Organization Web Address: Principal activity/ product/service of your work unit: How many people …on projects or programs you report to you directly? manage? STANFORD ADVANCED PROJECT MANAGEMENT PROGRAM APPLICATION FORM Responsibilities and Experience Please describe your current duties and responsibilities, particularly as they relate to project management, program management, or project portfolio management in your organization. Length of time in position: Total no. years of management experience: Please summarize any project, program, or project portfolio management experience you gained in previous positions – including experience as a project team member, project sponsor, or executive with project management oversight. (NOTE: If you wish, you may also e-mail a current resume or position description along with completing this portion of the application.) Education & Professional Development College/University Degree Year Project Management Professional (PMP) Certification Yes - Number/Year No Other Project Management Training/Education Organization/Institution Other Professional Development/Certificates Organization/Institution Objectives What do you hope to achieve through your participation in the Stanford Advanced Project Management Program? 2 STANFORD ADVANCED PROJECT MANAGEMENT PROGRAM APPLICATION FORM What function best describes your responsibilities? Accounting / Control Information Services Product Development Consulting Legal / Regulatory Project Management Engineering Logistics Program Management Finance Manufacturing Portfolio Management General Management Operations Project Office Management Human Resources Planning Research and Development Other Industry (check the most appropriate box) Business Services/Consulting Financial Services/Banking/Acctg Pharmaceuticals Computer/IT Government Telecommunications Construction Health Care/Medical Transportation Defense Insurance Utilities Education Manufacturing Other Please indicate how you heard about this program. (Indicate all that apply) REFERRAL FROM: Previous Participant: (insert name) IPSolutions Representative: (insert name) Human Resources Director: (insert name) Other: (insert name) RECEIVED MAILER: Brochure Postcard Letter Other (specify) INTERNET: Initially performed own Web search Saw ad or other marketing materials and went to Web site E-MAIL FROM: (specify) _____________ ADVERTISEMENT IN: (specify) ______________ ATTENDED: Other Stanford Center for Professional (specify program / year) Development program: Other IPSolutions program: (specify) Trade Show/Conference: (specify) Other: (specify) 3 STANFORD ADVANCED PROJECT MANAGEMENT PROGRAM APPLICATION FORM Program Fee Tuition □ Advanced Project Management Program US$5,200 The fee covers the following six modules: Converting Strategy into Action: Mastering the Integrated Program: Mastering the Project Portfolio: Leveraging the Customer Relationship: Designing the Organization for Execution Leadership for Strategic Execution Application To apply, please complete and fax the registration form included in this brochure to: Jomie Leung International Marketing Consultant - Stanford Advanced Project Management BR Guidance C/O China Education (HK) Ltd 3003, Shun Tak Center 200 Connaught Road, Sheungwan, Hong Kong Tel : 852-9133 2382 Email : firstname.lastname@example.org Once you have been admitted to our program, an acknowledgement letter will be sent within two weeks. Application does not guarantee admission; an Admissions Committee will review all complete applications and confirm with the applicant within two weeks. REGISTRATION POLICIES CANCELLATIONS, SUBSTITUTIONS AND TRANSFER The following cancellations, substitutions and fee schedule applies to all registrations: # of Weeks before Program Substitutions Transfer Fee Cancellation Fee Allowed > 4 Weeks Yes, if appropriate None None 3 to 4 Weeks Yes, if appropriate 25% of tuition 50% of tuition 0 to 2 Weeks Yes, if appropriate 50% of tuition 100% of tuition Request to transfer or cancel must be made in writing and faxed to China Education Group at 852- 25370549 or emailed to email@example.com. Stanford Center for Professional Development and China Education Group reserve the right to accept or reject substitutes for programs that require minimum management levels. Confirmed participants who have not provided advance cancellation notice in writing to China Education Group will forfeit the entire tuition amount. All tuition, fees, dates, policies and programs are subject to change. Mail or fax completed registration form to: China Education (HK) Ltd 3003, Shun Tak Center 200 Connaught Road, Sheungwan, Hong Kong Phone: 852-2537 0541 Fax: 852-2537 0549 Email : firstname.lastname@example.org Please note: Payment must accompany all registrations in order to reserve your seat. Please issue the International Bank Draft favoring to BR Guidance or make the transfer to HSBC Hong Kong DBS Bank (Hong Kong) Limited Account no. 555 8 041 736 Account no. 016-484-848020303 Favoring : Jomie Leung Favoring : BR Guidance SWIFT HSBCHKHHHKH SWIFT DHBKHKHH via Swift MT100/MT103 4 STANFORD ADVANCED PROJECT MANAGEMENT PROGRAM APPLICATION FORM Applicant Agreement I acknowledge that the information I have provided above is complete and truthful. _________________________________________________________________________________________________________ Signature of Applicant Date Print Applicant’s Name Manager Approval I support this applicant’s participation in the Stanford Advanced Project Management program. _________________________________________________________________________________________________________ Signature of Applicant’s Immediate Manager Date Manager’s Name Phone Title Email rev. 07/15/06 JL 5
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