Schemes for Professional Engineers

Sainsbury Management Fellowships: Application Form

Please complete the form and click the Submit button at the bottom of the page. Once you submitted the form, you will receive a confirmation e-mail at the e-mail address you give on the form.

(*) Indicates required fields

	1. Personal details
	Surname*
	Forenames*
	Title*
	Nationality*
	Date of birth*
	Address* for correspondence about this application
	E-mail*
	Telephone including the area code
	Day*
	Home*
	2. Education Profile
	A-levels and above* Please include dates (from and to), establishments and qualifications including course title, grades, class of honours.
	GCSEs* Please include dates (from and to), establishments and qualifications including course title, grades, class of honours.
	3. Membership of professional bodies* Please state dates, bodies and grade of membership where possible.
	4. GMAT* If taken please state dates (registered and taken) and scores (verbal, quantitative, total, writing).
	5. Proposed course* Please state entry date, business school and whether or not the place is confirmed. Alternatives may be listed in order of preference.
	6. Employment profile* Please list Employment history since graduation (earliest first), stating dates (from and to), employer/location, job description, salary (start and finish per job and current salary).
	7. Present employer
	Please state whether or not you intend to return to your present/last employer	YES NO
	Please state when your present employer may be consulted about this application	NOW IF SHORTLISTED NOT AT ALL
	8. References* Please nominate two referees who occupy senior positions within industry or academia, one of whom should be employed within your present company. Briefly explain their relationship to you. Give names, addresses and telephone numbers.
	9. Personal achievements* List any distinctive achievements, extra-curricular as well as professional, which you consider are indicative of your qualities, initiative and potential for top management. Give relevant dates.
	10. Linguistic abilities* Please summarise your abilities in each extra language in terms of reading, writing and speaking, categorising with the terms 'poor', 'fair', 'good' or 'fluent'.
	11. Other relevant information* This space may be used for any additional information you may wish to bring to the attention of the selectors
	12. Reasons for applying* Describe using no more than 400 words your plans and ambitions for the future and the relevance of the MBA course in achieving these goals.
	Please check the information you have entered, and then enter your name and the date to show that you have agreed that all the information you have provided is accurate.
	Date*
	Signed*
	Before you can submit your request, we need to make sure it is not an automated computer program that's submitting the form. To achieve this, please enter the two words displayed below in the textbox, separated by a space.

Please click only ONCE and wait for the form to be submitted.

Please send the form to:

Anne Mahabal
Scheme Administrator, Postgraduate & Professional Development

Updated February 2013

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