Leading and Building A Culture of Innovation: Personal Data
Leading and Building A Culture of Innovation: Personal Data
Personal Data
NOTE: If you are completing an application on someone else's behalf, you must be logged-in as that person. If you are not
the person specified above or below, please follow this link to logout.
denotes a required field.
Prefix (Mr., Ms.): Suffix (Jr., II): Nickname/Familiar Name for Badge:
Mr. Sherif
US CITIZENS: As an education provider we are asked by many groups, including our own leadership, executive education
guides, and the press, to describe the ethnic/racial backgrounds of our participants and employees. In order to respond to these
requests, we ask US citizens to answer the following two questions.
View Definitions
Regardless of your answer to the prior question, please check one or more of the following groups in which you consider yourself
to be a member:
We understand that your racial, ethnic, and cultural background may not be fully captured by the above options. Please feel free
to use the space below to share more about your racial, ethnicity, or cultural identity.
Arab
Email:
[email protected]
Statement of Truth
It is the applicant’s responsibility to notify Harvard Business School of any change in employment status that occurs between the
time this application is submitted and the start of the program.
By checking this box, I certify that all the information and accompanying material provided in connection with this application are
authentic and accurate.
Contact Data
Company/Organization Address
Home Address
City: State:
Business
Organizational Data
CONFIDENTIAL: The information you provide below is for use by the Admissions Committee only.
Products/Services:
Annual Sales Volume (in USD): Number of Employees:
Your Company/Division
Products/Services:
Managing a portfolio of investments in clean tech ventures, Real Estate, Trading and
Services
Annual Sales Volume (in USD): Number of Employees:
$1 - $4.9 million 100 - 499
How many reporting levels are above you, including the chief executive officer of the parent company?
0
Professional Data
Work Experience
Please list your three most recent positions in reverse chronological order, starting with your current, or most recent one. If all
positions are in the same company, please give the major promotional sequence.
1. Name of Company: Title or Position:
From: To:
From: To:
Please describe your current responsibilities including your level in the organization.
Please write an executive summary, describing the innovation-related challenges confronting your organization.
Education
If you have attended other Harvard Business School programs, please list them below.
1. Program: Date (MM/YYYY):
Objectives
Please explain your learning objective and describe what you think other participants will learn from you.
Please provide the nominating executive’s contact information. The nominating executive may be a senior executive or board
member within the organization, or a Harvard Business School alumni member familiar with the candidate. Please note that the
nominating executive must be someone other than the applicant. HBS may contact the nominating executive as part of the
application review process.
First Name: Middle Initial: Last Name:
City: State:
Invoicing Information
City: State:
Proficiency in spoken and written English is essential for participation in Harvard Business School Executive Education programs.
Cancellation
Payment is due within 30 days of the invoice date. Cancellations or deferrals must be submitted in writing more than 30 days
before the start of the program to receive a full refund. Due to program demand and the volume of preprogram preparation,
cancellations or deferrals received 14–30 days prior to the start of the program are subject to a fee of one-half of the program fee.
Requests received within 14 days are subject to full payment.
I have read the cancellation policy and agree to the terms stated: (please initial here)
Payment Terms
Upon acceptance, payment is required prior to program start date.
Harvard Business School (HBS) is governed by a set of community values that foster honesty, respect for others, and
accountability for one’s actions. HBS considers these values essential for a safe and productive learning environment for all.
Harvard Business School reserves the right to withdraw an offer of admission in the event that any part of your application contains
misrepresentations, or if you engage in, or have engaged in, behavior that violates HBS Community Values.
Discrimination Policy
In accordance with Harvard University policy, Harvard Business School does not discriminate against any person on the basis of
race, color, sex or sexual orientation, gender identity, religion, age, national or ethnic origin, political beliefs, veteran status, or
disability in admission to, access to, treatment in, or employment in its programs and activities.
The Admissions Committee will email a receipt of your completed application immediately by email. If you do not receive an email
acknowledgement within 30 minutes of submission, it is likely that your application was not received. Please contact us by email (
[email protected]) or phone (+1 617-495-6226) in this instance.