2 Two name cards 二张名片 Photocopies of NRIC/Passport/Citizenship Certificate/Singapore Permanent Resident Status 护照 / 身份证 / 新加坡永久居民身份证的复印件 Non-refundab

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1 1 南洋 EMBA 报名申请表及申请材料清单 Nanyang EMBA Application Form and Checklist Please submit the completed application, duly signed by the applicant, together with the supporting documents. You may indicate N.A. wherever it is not applicable to you. All information provided in the application form will be treated in confidence. 为使您的申请得到及时处理, 请提交完整的申请人签名的报名表及所需材料对报名表中某些不适用于您的栏目, 请注明 N.A. 所有信息会受严格保密 Checklist 申请材料清单 Before sealing the envelope, please to ensure that you have included all the following: 在签封之前, 请划确认您递交的以下材料 : Application form duly completed and signed 完整填写并签名的申请表 Certified true copy of degree scrolls in Chinese and English 中英文版本的学历学位证书复印件 ( 英文件必须由就读院校开具, 或者由公证处公证 ) Chinese and English transcripts of academic records from each university attended 所有就读院校的中英文成绩单原件 ( 英文件必须由就读院校开具, 或者经由公证处公证 ) Two referee s reports in sealed envelopes. Referees reports should come from people who can objectively comment on applicant s expertise and management ability, with one report coming from the CEO of the applicant s company to comment on the applicant s potential for promotion. 两封密封的推荐信推荐人该能就申请人的专业经验和管理能力发表评论其中一封应出自申请人就职的公司总裁, 客观地评价申请人晋升高级管理层的潜能 Professional membership certificates, if any 专业技术资格证书 ( 如果有 ) Statement of objectives and motivations 一篇有关个人学习动机的陈述 Resume 一份详细的工作履历表 An organizational chart indicating the applicant s position 一份所在机构的组织结构图, 注明申请人所在的位置 Company's Approval Letter (for company sponsored applicants only) 公司支持信 ( 适用于由公司资助的申请人 ) Two passport size photographs (with applicant's name written on the back of each photograph) 两张护照型近照 ( 请在照片背面写上申请人的名字 )

2 2 Two name cards 二张名片 Photocopies of NRIC/Passport/Citizenship Certificate/Singapore Permanent Resident Status 护照 / 身份证 / 新加坡永久居民身份证的复印件 Non-refundable application fee of RMB1500 or S$ (inclusive of GST) made payable to Nanyang Technological University. Applicant's name, address and contact numbers should be written on the back of the cheque or bank draft. 支付给 Nanyang Technological University 的报名费人民币 1500 元或新币 300 元 ( 不退还 ) 请注意在支票或者汇票背面写上申请人姓名地址和联系方式 Modes of Payment 缴费方式 : 1) Cheque or Bank Draft by mail to Nanyang EMBA Office in Singapore or delivered by hand to Nanyang EMBA Staff. 把支票寄给新加坡南洋 EMBA 办公室, 或面交给新加坡南洋 EMBA 工作人员如果用银行汇票方式支付, 请把汇票复印件寄给新加坡南洋 EMBA 办公室 Payee:Nanyang Technological University 收款人 :Nanyang Technological University Applicant's name and contacts shall be written on the back of the cheque or bank draft 请务必在银行支票或汇票背面注明申请人的姓名和联系方式 2) Telegraphic Transfer (please keep the receipt) 以电汇方式支付学员需按照缴费通知单的要求将学费电汇到南洋 EMBA 课程的新币帐号, 并保留汇款存单 Bank charges shall be borne by the applicant. 电汇手续费和银行的其它收费由汇款人承担 Applicant's name shall be stated in the Telegraphic Transfer. Account Details 南洋理工大学银行新币帐户细节 : 户名 (Account Name) Nanyang Technological University 开户银行 (Bank Name) OCBC Bank ( 华侨银行 ) 开户行地址 (Bank Address) Swift Code 65 Chulia Street Singapore OCBC SGSG 开户行分行 (Bank Branch) NTU Branch 开户行分行编号 (Bank Branch Number) 537 华侨银行编号 (OCBC Bank Code) 7339 南洋理工大学银行帐号 (NTU Bank Account No.) Please submit the checklist with all the application documents to us. Applications with incomplete documents will delay the processing. 请将材料清单和所有申请材料一起递交材料不完整的申请会延误审批

3 3 南洋 EMBA 课程 Nanyang EMBA Program 申请表格 Application Form 请贴一张护照型近照个人资料 PERSONAL DATA 姓名 ( 与身份证及护照上的显示一致 ) Name as in NRIC or passport 称呼 ( 请划圈 ): 先生 / 太太 / 女士 / 小姐 Salutation(please circle): Mr/Mrs/Mdm/Miss 姓 ( 英文 )Last Name: 名 ( 英文 )First Name: 中文姓名 : 身份证号码护照号码 : NRIC No. Passport No. 婚姻状况 : 已婚未婚性别 : 男女 Marital Status : Married Single Gender: Male Female 出生日期 : 年月日出生地 : Date of Birth (dd/mm/yy) : Place of Birth: 国籍中国其他, 请注明 Citizenship China Others, please specify: 家庭住址 Home Address: ( 中文 ) ( 英文 ) 办公住址 Office Address: ( 中文 ) ( 英文 ) 邮编 : Postal Code: 邮编 : Postal Code: 您希望我们将邮件寄到 : 家庭住址办公地址 Please send mails to: Home Address Company address 电话号码 : ( 住宅 ) ( 公司 ) Telephone No. : (Home) (Office) 手机 : 传真 : Mobile phone: Fax: 电子邮件 /

4 工作背景 Work Experience 4 全职工作经验共 Full-time Work Experience : 目前就职于 ( 中文 ): Current Employer: 年 Years 公司总资产 : 元年度销售额 : 元是否为上市公司 : 是否 Total Assets: Annual Turnover: Listed Company: Yes No 职务 ( 中文 ): 担任此职务年限 : 年 Designation: Years in Position: Years 公司员工人数 Number of Employees in the Company : 您属下员工人数 Number of Employees under Your Supervision : 您直接上司的职务 The Position of Your Immediate Supervisor : 请标明贵公司行业类别 / Please categorize your organization into : 金融 / 咨询业 Financial services / Consultancy 电信 / 信息产业 Telecom/Information Technology 医药 / 生物工程 Pharmaceuticals / Biotech Industry 建筑 / 房地产 Architecture/Real Estate/Construction 日用消费品产业 Consumer Products 制造业 Manufacturing 商业贸易 Trade/Commerce 政府管理 Public Administration 教育 Education 文化产业 Cultural Industry 其他, 请注明 Others (Please Specify ) 请标明贵公司性质 /Please indicate your company ownership: 国营 State-owned 私营 / 集体 Private 外资, 请标明外方国别 Foreign-invested (Please specify country / region ) 其他 Others 请描述您现在所担任的职位和职责范围 : Describe your current position and the scope of your responsibilities: 请按照先近后远的顺序依次填写您的工作经历 ( 如果必要请用附加纸 ) Please indicate in reverse chronological order your full-time employment history (Please attach additional pages if necessary). 起 ( 年 / 月 ) From ( mm/yy ) 止 ( 年 / 月 ) To ( mm/yy ) 公司 Organization 职务 Designation 主要职责 Responsibility 目前年收入 / Current Annual Income : 低于 / Below 600,000 RMB 800,001RMB 900,000 RMB 600,001 RMB 700,000 RMB 900,001 RMB 1,000,000 RMB 700,001 RMB 800,000 RMB 高于 1,000,000 RMB

5 5 教育背景 EDUCATIONAL BACKGROUND 请附上大学成绩单原件学位证书和职称专业证书复印件和公证书原件 Please attach certified true copies and photocopies of degree scrolls, professional certificates and academic transcripts. A. 请按照时间顺序填入您所就读的大学或学院 ( 包括本科和研究生 ) Please list in chronological order the college or university you ve attended. (Undergraduate and postgraduate) 大学 / 所在国 University/Country 起 ( 年 ) From (Year) 止 ( 年 ) To (Year) 主修 Major 所获学位 Qualification Obtained B. 目前就读的课程 Courses you are currently pursuing 课程 Course 教育机构 Institute 预期完成日 Expected Completion Date C. 专业资格 / 会员 Professional Qualifications/Membership 专业机构 / 所在国 Professional Board/Country 认证情况 Award Details 认证时间 Date of Award D. 英语熟练程度 English Language Proficiency 请注明英语熟练程度的等级 : 熟练, 良好, 一般 Please state level of proficiency: Excellent, Good, Fair 书写 Written 阅读 Read 口头表达 Spoken 申请人可以列出 GMAT, TOEFL 成绩, 不过这类考试并非入学要求 GMAT, TOEFL scores maybe included in the application, but they are not prerequisite for admission. GMAT 成绩 GMAT Score: 写作分析 Analytical Writing 计算 Quantitative 语言 Verbal 总分 Total TOEFL 成绩 TOEFL Score: 短文写作 Essay Writing 结构 Structure 听力 Listening 阅读 Reading 总分 Total

6 6 推荐人 REFEREES 请列出二位能够对您的专业水平和管理业绩进行中肯评价的人士请让推荐人使用所附的推荐信表格 Name two referees who are in a position to assess your professional/managerial performance. Please use the attached Letter of Reference Form to request their recommendations (A) 姓名 Name 公司名称 / 地址 Company Name/Address 职位 Designation 联系电话 Phone number (B) 姓名 Name 公司名称 / 地址 Company Name/Address 职位 Designation 联系电话 Phone number 公司支持信 COMPANY APPROVAL LETTER 请让贵公司的授权代表出具一封公司的支持信此信确认贵公司对您在 EMBA 课程里所需的时间投入表示支持请使用所附的公司支持信表格 Please have an authorized representative in your company submit an approval letter. This letter comfirms that your organization understands the time commitment required of the EMBA program. Please use the attached Approval Letter Form. 姓名 Name 职位 Designation 公司名称 Company Name 地址 / 电话号码 Address/Telephone

7 7 资金来源 SOURCE OF FINANCE 公司支付 Employer Sponsorship (Percentage) _% 自己支付 Self Support (Percentage) % 其他, 请注明 Others Please specify 调查 SURVEY 您是从以下哪个渠道了解南洋 EMBA 课程的? 报纸杂志广告, 请列出名称 : 路演 (Road show) 南洋理工大学的材料介绍南洋理工大学校友 / 教职员工 / 学生, 请列出姓名 : 上海交通大学校友 / 教职员工 / 学生本公司管理层 / 人力资源部门同事或朋友其他

8 8 声明 DECLARATION (A) 我保证所填写的一切信息属实 I affirm that all statements made by me on this form are correct. (B) 我明白由于提供不准确或错误信息 ( 包括对重要信息的隐瞒 ) 将使这份申请无效, 如果已被录取, 经查后将被要求退出这一课程 I understand that any inaccurate or false information (or concealment of important information) will render this application invalid and that, if admitted on the basis of such information, can be asked to withdraw from the program. 申请人签名 Signature of Applicant 日期 Date 请附上二张名片 Please staple two name cards. ( 不要粘, 钉上即可 )Do not stick them

9 9 为了保密, 在将此信交给申请人之前, 请在信封封口处签字 To ensure confidentiality, please seal the envelope and sign on the seal line before giving the report to the applicant for submission. 保密 Confidential 南洋 EMBA 课程 Nanyang EMBA Program 推荐信 Referee s report 申请人填写 TO BE COMPLETED BY APPLICANT 请把下栏填完后交给您的推荐人 Please fill in your name before you pass this form to your referee for completion. 申请人姓名 Name : ( 中文 ) ( 英文 ) 尊敬的推荐人 DEAR REFEREE 上述申请人正在申请南洋 EMBA 课程 EMBA 课程主任希望能够得到您对申请人的评估谢谢! The above-named applicant is applying for admission to the Nanyang EMBA. The Director of the Nanyang EMBA would appreciate receiving your confidential assessment of the applicant. 1 您认识申请人有多久? 对他 / 她的了解程度如何?How long have you known the applicant and in what capacity? 2 与近年来您所了解的和申请人处于相当职位的员工相比, 您如何评价申请人?( 请在下表中选择一项 ) Among the employees at a similar level whom you have known in recent years, how would you rate the applicant? (Please tick one box below) 优秀 Excellent ( 位于前 / Top 5%) 中等 Average ( 位于前 / Top 40%) 很好 Very Good ( 位于前 / Top 15%) 较差 Poor ( 位于后 / Bottom 30%) 好 Good ( 位于前 / Top 30%) 无法评价 Unable to rate 3 请在下表打钩对申请人作出评价 Please rate the applicant s skills and ability in the following categories: 较差 Poor 中等 Average 好 Good 很好 Very Good 优秀 Excellent 无法评价 Unable to rate (i) 学习能力 Academic ability (ii) 分析能力 Analytical skill (iii) 求学动机 Motivation for graduate study

10 10 (iv) 与他人共事能力 Ability to work with others (v) 创造能力 Creativity & resourcefulness (vi) 个人素质 Personal integrity (vii) 口头表达能力 Communication skill- Oral (viii) 书面表达能力 Communication skill- Written (ix) 成熟程度 Maturity (x) 领导才能 Leadership skills 4 请评估申请人是否有能力完成硕士课程, 同时请指出申请人在哪些方面还有待提高 Please comment on the applicant s ability to complete a graduate program. Please also indicate in which areas the applicant needs to improve. 5 您是否推荐申请人报读南洋商学院 EMBA 课程?( 请打钩 ) Do you recommend the applicant for admission to the Nanyang EMBA program? (Please tick one box below) 极力推荐 Strongly recommend 推荐 Recommend 有保留的推荐 Recommend with reservations 不推荐 Do not recommend 推荐人签名 Signature of Referee 日期 Date 推荐人姓名 Name of Referee : ( 中文 ) ( 英文 ) 职位 Designation : 公司名称 / 地址 Company/Address : 电话 Tel: 电子邮件

11 11 为了保密, 在将此信交给申请人之前, 请在信封封口处签字 To ensure confidentiality, please seal the envelope and sign on the seal line before giving the report to the applicant for submission. 保密 Confidential 南洋 EMBA 课程 Nanyang EMBA Program 推荐信 Referee s report 申请人填写 TO BE COMPLETED BY APPLICANT 请把下栏填完后交给您的推荐人 Please fill in your name before you pass this form to your referee for completion. 申请人姓名 Name : ( 中文 ) ( 英文 ) 尊敬的推荐人 DEAR REFEREE 上述申请人正在申请南洋 EMBA 课程 EMBA 课程主任希望能够得到您对申请人的评估谢谢! The above-named applicant is applying for admission to the Nanyang EMBA. The Director of the Nanyang EMBA would appreciate receiving your confidential assessment of the applicant. 1 您认识申请人有多久? 对他 / 她的了解程度如何?How long have you known the applicant and in what capacity? 2 与近年来您所了解的和申请人处于相当职位的员工相比, 您如何评价申请人?( 请在下表中选择一项 ) Among the employees at a similar level whom you have known in recent years, how would you rate the applicant? (Please tick one box below) 优秀 Excellent ( 位于前 / Top 5%) 中等 Average ( 位于前 / Top 40%) 很好 Very Good ( 位于前 / Top 15%) 较差 Poor ( 位于后 / Bottom 30%) 好 Good ( 位于前 / Top 30%) 无法评价 Unable to rate 3 请在下表打钩对申请人作出评价 Please rate the applicant s skills and ability in the following categories: 较差 Poor 中等 Average 好 Good 很好 Very Good 优秀 Excellent 无法评价 Unable to rate (i) 学习能力 Academic ability (ii) 分析能力 Analytical skill (iii) 求学动机 Motivation for graduate study

12 12 (iv) 与他人共事能力 Ability to work with others (v) 创造能力 Creativity & resourcefulness (vi) 个人素质 Personal integrity (vii) 口头表达能力 Communication skill- Oral (viii) 书面表达能力 Communication skill- Written (ix) 成熟程度 Maturity (x) 领导才能 Leadership skills 9 请评估申请人是否有能力完成硕士课程, 同时请指出申请人在哪些方面还有待提高 Please comment on the applicant s ability to complete a graduate program. Please also indicate in which areas the applicant needs to improve. 10 您是否推荐申请人报读南洋 EMBA 项目?( 请打钩 ) Do you recommend the applicant for admission to the Nanyang EMBA program? (Please tick one box below) 极力推荐 Strongly recommend 推荐 Recommend 有保留的推荐 Recommend with reservations 不推荐 Do not recommend 推荐人签名 Signature of Referee 日期 Date 推荐人姓名 Name of Referee : ( 中文 ) ( 英文 ) 职位 Designation : 公司名称 / 地址 Company/Address : 电话 Tel: 电子邮件

13 为了保密, 在将此信交给申请人之前, 请在信封封口处签字 To ensure confidentiality, please seal the envelope and sign on the seal line before giving the report to the applicant for submission.

13 13 为了保密, 在将此信交给申请人之前, 请在信封封口处签字 To ensure confidentiality, please seal the envelope and sign on the seal line before giving the report to the applicant for submission. 保密 Confidential 南洋 EMBA 课程 Nanyang EMBA Program 公司支持信 Company Approval Letter 申请人填写 TO BE COMPLETED BY APPLICANT 南洋 EMBA 课程包括 18 门课中国授课时间安排在每个月的一个周四到周日, 海外授课时间大多安排在国庆长假期间修完所有课程大约需要 2 年因此, 您必须取得公司的支持以完成这一学业请让公司的授权人填写以下表格 The curriculum of the Nanyang EMBA program consists of 18 subjects, which will be conducted from Thursday to Sunday every month in China, or in Singapore for two weeks during the Chinese national day holiday. The duration of the program is around 2 years. Your application must, therefore, have the support of your present employer. Please request the authorized representative of your company to sign this form. 申请人姓名 Name : ( 中文 ) ( 英文 ) 公司填写 TO BE COMPLETED BY EMPLOYER 姓名 Name : ( 中文 ) ( 英文 ) 职位 Designation : 公司名称 / 地址 Company/Address : 电话 Tel: 电子邮件我声明支持这份申请我确认公司将给予申请人适当的假期上课和考试 I hereby support this application. I confirm that the company will grant him/her leave to attend classes and take examinations as required by the University. 签名 Signature 日期 Date

PERSONAL PARTICULARS 个人资料 ( 续 ) Citizenship (Please tick and attach a certified true copy pf your birth certificate, NRIC, Passport or Citizenship

PERSONAL PARTICULARS 个人资料 ( 续 ) Citizenship (Please tick and attach a certified true copy pf your birth certificate, NRIC, Passport or Citizenship 南洋公共管理研究生院 Master of Public Administration Programme 公共管理硕士学位项目 Application For Admission 入学申请表格 Admission Year 2012/13 入学年份 2012/2013 Passport-sized photograph 请贴上护照型近

2 Two name cards 二张名片 Photocopies of NRIC/Passport/Citizenship Certificate/Singapore Permanent Resident Status 护照 / 身份 证 / 新加坡永久居民身份证的复印件 Non-refundab

2 Two name cards 二张名片 Photocopies of NRIC/Passport/Citizenship Certificate/Singapore Permanent Resident Status 护照 / 身份证 / 新加坡永久居民身份证的复印件 Non-refundab