APPLICATION FOR ADMISSION TO ITESM-Campus Monterrey

Transcription

1 APPLICATION FOR ADMISSION TO ITESM-Campus Monterrey For use only by students applying to the MBA-GBS program offered by The University of North Carolina at Charlotte (UNC Charlotte) and Instituto Tecnológico y de Estudios Superiores de Monterrey (ITESM) in Monterrey, Mexico Please complete and return this application to: Office of Academic Services at EGADE Ave. Fundadores y Rufino Tamayo Valle Oriente, Garza García, NL. C.P MEXICO PLEASE PRINT CLEARLY AND IN CAPITAL LETTERS UNCC SID: - - For official use only: EGADE SID: Attach Fee Here Processing Fee Staple your check or credit card payment form in the upper left-hand corner of this application. Please note that the processing fee is required for each application submitted and is non-transferable and non-refundable. Applications submitted without this fee will not be processed. Checks should be made out in US Dollars and made payable to ITESM Campus Monterrey. Application Deadline A complete application package including test scores must be received by or before the application deadline date. Program Information I am applying to the graduate MBA-GBS program offered by UNC Charlotte and ITESM in Monterrey, Mexico. When do you plan to enroll? Full time program September 20 Part time program January 20 Part time program September 20 Personal Information Have you been a student at the Tecnológico de Monterrey? Yes No If you answered yes to the previous question, please write your student identification number (DIN) : Campus of origin: (For transferred students) Full Legal Name (as it appears on your social security card or on your passport) Last Name First Name Middle Name Suffix (i.e., Jr.) List any former names or name variations that may appear on official records. Sex: [M] Male [F] Female Date of Birth / / OISA BELK /

2 Marital Status (optional): Married Separated Divorced Single Widowed Live-in partner Place of birth: City: County: State: Country: Nationality: Mexican Foreign Specify: Is your father a Tec de Monterrey graduate? If so, please write his student identification number: Is your mother a Monterrey Tech graduate? If so, please write her student identification number: Address and Contact Information Address Permanent Address (address must be in the country in which you hold citizenship or permanent legal residency) / / Country Code / City Code / Current Mailing Address / / Country Code / City Code / Local Mailing Address (Where you will live while studying at Tecnológico de Monterrey, if this is not your permanent residence. You can skip this question if you don t have this information yet. However, it is your responsibility to notify your local address to the Institute within the first month of classes.) / / Country Code / City Code / 2

3 Current Employment Information (Skip this section if you are not working currently. Do not abbreviate) Employer: Employer Address Employer Mailing Address / / Country Code / City Code / Current monthly salary (optional) (Skip this section if you are not working currently. This information is only for statistical purposes) $ 0 - $1000 USD $ $4000 USD $ $2000 USD $ $5000 USD $ $3000 USD > $50000 USD Academic Background High School institution: Full name: Date of high school certificate conferral: The high school institution you attended is: Public Private High School Mailing Address In chronological order, list all college, universities, and specialized institutions you have attended. Attach supplemental list if necessary. Applicants to the MBA-GBS program must provide two certified/official transcripts (and English translations) of each college/university attended (including UNC Charlotte and ITESM Campus Monterrey). 3

4 University/College (first attended): Full name: Date of degree conferral: Degree Conferred: The University/College you attended is: Public Private University/College Mailing Address University/College (second attended): Full name: Date of degree conferral: Degree Conferred: The University/College you attended is: Public Private University/College Mailing Address Graduate Institution (if applicable) Full name: 4

5 Date of degree conferral: Degree Conferred: The Graduate Institution you attended is: Public Private Graduate Institution Mailing Address Test Data ATTENTION: All test scores, including TOEFL and GMAT, should be reported directly to ITESM s EGADE in Monterrey, Mexico and to The Belk College of Business at UNC Charlotte. TEST OF ENGLISH AS A FOREIGN LANGUAGE (TOEFL): Graduate international applicants must provide proof of satisfactory command of the English (American) language. TOEFL scores more than two (2) years old will not be accepted. Applicants who are citizens of, or who have received an associate s degree or higher in one of the following countries, are exempt from the English language proficiency requirement: Australia, British Caribbean and British West Indies, Canada (except Quebec), Ireland, Liberia, New Zealand, United Kingdom, and United States. They must, however, submit proof of having earned a US degree. To be considered for admission, graduate applicants must submit a minimum TOEFL score of 557 (on the paper-and-pencil test) or 220 (on the computer-based test). I have taken or will take TOEFL on: / / GRADUATE MANAGEMENT ADMISSIONS TEST (GMAT) or PRUEBA DE ADMISIÓN A ESTUDIOS DE POSGRADO (PAEP): Scores more than two (2) years old cannot be accepted. I have taken or will take GMAT / PAEP on: / / Citizenship and Non-Immigrant Visa Information Country of Birth: City of Birth: Country of Citizenship: Country of Permanent Residency: Country which issued/will issue my passport: NOTE: Students who choose to attend commencement (i.e. graduation ceremonies) at UNC Charlotte upon completion of the program, will be required to obtain an appropriate visa before entering the United States. Additional information about these options will be provided at a later time to students enrolled in the MBA-GBS program. 5

6 How did you first learn about the MBA-GBS Program? Check one: Friend/Family Web Publication. Which? Belk College of Business / UNC Charlotte website EGADE / ITESM Website Print Publication. Which? Other. Please explain: I am a current/former student of Belk College of Business (UNC Charlotte) I am a current/former student of EGADE (ITESM) 6

7 Certification Have you ever been convicted of a criminal offense other than a minor traffic violation? Yes No Are there such criminal charges pending against you at this time? Yes No Have you ever been dismissed, suspended or placed on probation by any school? Yes No If you answered "yes" to any of these three questions, please explain the circumstances on a separate sheet and submit it with this application. I hereby certify that the above information is accurate. I understand that falsifying or withholding information in completing this application constitutes grounds for immediate withdrawal of my application from further consideration, cancellation of admission, or registration. By signing this application, I accept the Principles, Mission and General Statute of the Tecnológico de Monterrey, as well as the characteristics of its education process, its norms and rules. I also accept the following: a. It is my responsibility, if I am admitted as a student of Tecnológico de Monterrey, to provide a laptop computer with access to Internet for my personal use. b. Conduct myself with honesty as a student of Tecnológico de Monterrey, as it is stipulated in its mission. My Name (in capital letters / Roman alphabet) My Signature Date / / I authorize Tecnológico de Monterrey to submit the information contained in this application for purposes of employment opportunities and/or promotional events: Yes No 7