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Home > Events & Programs > TUCK-WBENC Executive Program > TUCK-WBENC Program Application

TUCK-WBENC Executive Program

Tuck-WBENC Executive Program Brought to you by IBM

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All information is confidential.

* = Required Field

Participant Information Mrs.Ms.Dr. Name (First, MI, Last Name):*
Preferred First Name (for Tuck name tag):

Contact Information

Business Name:*

Job Title:*

Business Mailing Address:*

City*

State*

Zip Code*

Physical Business Address, if different than mailing address:

Business Phone:*

Fax:

Email:*

Website:

Home Address:*

City*

State*

Zip Code*

Phone:*

Fax:

Emergency Contact:*

Emergency Contact Phone:*

Company Information

Your Company Specializes in

Distributions Manufacturing Service Other If Other, please specify:

WBENC Certification #:

Date Certified:

Industry Code(s)*

Year Business Began:

No. of Years with the Company:

Employees

Number of Employees:

Full-time

Part-time

Volume of Sales for Years

2005:

2006:

2007:

Percentage of Revenues that are

Public: %

Private: %

Percentage of the Company You Own: %

What % of your business is

Local

Regional

National

International

Who are your major customers? Do you have a formal strategic plan for your business? YesNo

Please describe your current job position/function and responsibilities.

Your Professional Experience

	Strong	Moderate	Little/Nones
Accounting
Business Process
Business Strategy
Finance
Human Resources
Marketing

Total Years of Management Experience:

Billing To whom should the invoice for the program be directed? Name:*

Title:

Company:*

Address:*

City*

State*

Zip Code*

Phone:*

Email:

In the event that you are enrolled this person will be contacted to arrange for payment.

The $1,250 program fee includes tuition and course materials. Most meals and accommodations for the WBEs are provided by IBM.

APPLICATION DEADLINE

Early application is strongly encouraged. The final deadline for applications is July 18, 2008. Applications received after July 18th will be reviewed on a space-available basis only.

CANCELLATION POLICY

Cancellations must be submitted in writing and will be assessed as follows when received at WBENC:

At least 30 days before the program, full refund minus a $50 processing fee

15-29 days before the program, 50 percent refund

fewer than 15 days before the program, no refund

Both WBENC and the Tuck School actively support the equality of opportunity for all persons regardless of race or ethnic background, and no candidate shall be denied admission or otherwise be discriminated against because of race, color, creed, religion, sex, age, sexual orientation, national origin, or disability.

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TUCK-WBENC Executive Program

Tuck-WBENC Executive Program Brought to you by IBM

APPLICATION DEADLINE

CANCELLATION POLICY