Virginia Tech. Pamplin Executive MBA Program - Admissions

The following form is used to gather information in order to arrange a consultative interview with Dr. Charles Jacobina, Executive Director of the Pamplin EMBA Program or with the Assistant Director. This preliminary application will enable Dr. Jacobina to examine your credentials, experience, education and management responsibilities to better determine your likelihood for acceptance into the EMBA Program. Upon receipt of the form, we will contact you to arrange a time to meet with you.

Privacy Statement
The Pamplin EMBA Program is committed to respecting your privacy. Information submitted will only be used for the purpose of contacting you. This information will not be disclosed to a third party.

Contact Information

First Name
Middle Name
Last Name
E-mail Address
Confirm E-mail Address
Address (Line 1)
Address (Line 2)
City
State
Zip Code
Home Phone
Work Phone

Other Information

Undergraduate Institution
Undergraduate GPA and Major
Graduate Institution
Graduate degree or credit hours completed
Company Name
Business Title
Industry
Other (please specify)
Work Experience (years)

Please describe your current job function:

Survey Information

Prior to searching our program on the internet, how did you hear about us?
Other (please specify)

Please check the functions you are interested in attending:

Attend New Students' Reception	Date TBD, Westwood Country Club, Vienna, VA
Set up interview	To schedule an interview please call 703-538-3757
I am interested in starting the EMBA in:

Visit our Admission's page after submitting this preliminary application