NEN Faculty Development Courses 2011/2012

APPLICATION FOR ADMISSION

Kick-Starting the Entrepreneurial Campus
Please answer all questions applicable to you to the best of your ability. Application must be fully completed, signed and Sponsoring Signature received, before the Course Admissions Committee. Application Checklist: Completed Application Form Completed Scholarship Form (Only NEN institutional members) Sponsors Signature (NEN institutional members not availing scholarship and non-institutional members) PLEASE RETURN THIS APPLICATION TO: BY MAIL: Admissions Committee National Entrepreneurship Network Villa No. 2, Regent Place, Ground Floor, Thubarahalli, Varthur Main Road Bangalore 560 066 ONLINE: Application may be e-mailed to to neneducation@nenglobal.org FAX: Admissions Committee +91 080 4168 9195/93

GENERAL INFORMATION Name: ___________________________________________________________________________________________ Title or Position: __________________________________________________________ Male Female

Institute/Organization Name:__________________________________________________City:___________________ Area of Specialization: ______________________________________________________________________________ E-Mail Address: ____________________________________Contact No:______________________________________ Have you taught Entrepreneurship? Y/N If YES, how many months/years? _________________________ Which stream of students? Engineering Management Yes Others ____________________________ No

Have you attended the NEN Orientation Program?

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Have you attended any other course or workshop in Entrepreneurship? Yes No If YES, please give details like name of the program, course date, name of the institute/organization _________________________________________________________________________________________________ _________________________________________________________________________________________________ Please state your reason for applying to this course? _________________________________________________________________________________________________ _________________________________________________________________________________________________ Please mention how you plan to implement what you learn from this course on your campus. Tick as applicable Run series of topic specific workshops like Idea Generation, Opportunity Evaluation, Business Model Embed the content in the existing entrepreneurship course Launch an entrepreneurship course on campus Please choose your preferred location for this course: Gurgaon: June 24-26 Coimbatore: July 7-9 Bangalore: July 15-17 Mysore, Pune: July 22-24 Chennai, Mumbai: July 28-30 Hyderabad, Indore: Aug 5-7 Durgapur: Aug 12-14 EDUCATION Degree (Check only highest level attained):

BE/BA/BS

MS/MA

MBA

PhD Law Others Area of Specialization: _____________________________________________________________________________ University: _______________________________________________________________________________________ ENROLLING IN THE COURSE Application Deadline: The deadline for applying to the course is six weeks before the course start date. Below are the deadlines: For course in Gurgaon : May 16, 2011

For course in Coimbatore: May 26, 2011 Page 2 of 5

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For course in Bangalore: June 3, 2011 For course in Mysore: June 10, 2011 For course in Pune: June 10, 2011 For course in Chennai: June 16, 2011 For course in Mumbai: June 16, 2011 For course in Hyderabad: June 24, 2011 For course in Indore: June 24, 2011 For course in Durgapur: July 1, 2011
Application Review Process With the growing number and sophistication of entrepreneurship educators in India, the demand for the Advanced Courses, in particular, is strong, and we cannot guarantee space for all applicants. During the week following the application deadline, applications for the course will be reviewed by the Course Admissions Committee. The Course Admissions Committee will include members of NEN Trust, and may include the course Teaching Faculty, topic experts, and other senior NEN Faculty Leaders. We may follow up with you for clarifications post their meeting. Admission is based on the applicants demonstrated passion, execution track-record, ability and commitment to make a difference in building entrepreneurship programs for their students, or in supporting entrepreneurs. Notification of Application Status You will be notified by email of your application status by 1 week after the application deadline, which is 5 weeks before the course begins. If you have any questions about the status of your application, please call us at the office, or email us at neneducation@nenglobal.org. Course Fee NEN institutional members: INR 10,000 Non-Institutional members: INR 20,000 The course fees cover tuition, course materials including cases, and most meals. Travel and lodging costs must be borne by the candidate or their sponsoring institution. The NEN Education team will assist selected candidates in identifying and arranging affordable accommodation close to the program venue. Course Fee Due Date Along with the acceptance notification, successful applicants will receive a course invoice and payment instructions. Payment is due within 2 weeks of the invoice date. Late or missing payments can result in the applicants place being given to another candidate. Advance Preparation The course will have required advance reading and possibly other additional advance work. The advance preparation allows for the participant to extract much more value from the course, and for richer classroom interaction and a better experience

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for all. Once we receive your confirmation and your payment of course fees, you will receive emails notifying you of the advanced preparation requirements, and sent a link to any materials which you will be able to download. In addition, we will be in contact to help you make any travel and accommodation arrangements. Withdrawal Policy We do understand that last minute problems do occasionally arise, and that it is sometimes necessary to withdraw from a course at the last minute. In this case, we will refund most of the course fees, subtracting Rs. 3000 to cover the NEN Trust administrative costs associated with the participant. Course Cancellation Policy Program dates, course fees and teaching faculty may be subject to change. Please check the NEN website for updates before applying. If a program is cancelled by NEN, the participants total course fees will be refunded. If for any reason, the course cant be held on the scheduled dates reasons could include bandhs, weather or other problems NEN will work with the teaching faculty to reschedule the course, and the participants fees will be applied to the course on the new dates. NEN will not be responsible for travel, accommodation or other costs that may have been incurred by the participant. Scholarships Scholarships are available to cover the entire course fees for NEN Faculty Leaders. Scholarships are intended for NEN Faculty Leaders from institutes that are unable to afford the subsidized course fees. Scholarships are not guaranteed, and they are not awarded on a first-come-first-serve basis. Scholarships are awarded based on a combination of demonstrated merit and need. If you are interested in applying for a scholarship, please download the scholarship application Form on our website, fill and send it to us along with your course application. Successful applicants who qualify for the scholarship will be expected to confirm their attendance by making a fullyrefundable deposit payment of INR 5000 along with their course participation confirmation. The payment will be refunded immediately upon successful completion of the course. This refundable deposit is to ensure minimum last-minute drop-outs for the course. However, please note, in case you drop out for any reason within 5 days of the course, you will be eligible only for a partial refund of Rs.2000. This is to cover the administrative costs involved in the process. SPONSORING INFORMATION I confirm that we are responsible for the sponsorship of the above candidate and will meet the subsidized course fees within 2 weeks on receipt of the invoice or the withdrawal fee. I understand that this liability is not waived by termination of employment. Name of organization: ______________________________________________________________________________ Name of the Sponsoring Executive: _______________________________________________________________ Title or Position: ___________________________________________________________________________________ Telephone: _________________________________ E-Mail: ________________________________________________ Signature: ______________________________________________ Date: __________________________

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BILLING INFORMATION An invoice will be e-mailed to the individual indicated below. Name: ___________________________________________________________________________________________ Title or Position: ___________________________________________________________________________________ Institute/Organization Name: ________________________________________________________________________ Institute/Organization Address: _______________________________________________________________________ Telephone: __________________________________ E-Mail: _______________________________________________ AGREEMENT I understand and agree to the enrolling process and conditions and I confirm that details provided above are correct. Signatures _______________________________________ Applicant Name: Date: FOR MORE INFORMATION Please contact the NEN Education team at: Faculty Development Course Admissions Committee National Entrepreneurship Network Ground Floor, Villa No. 2, Regent Place Thubarahalli, Varthur Main Road ,Bangalore 560 066 E-Mail: neneducation@nenonline.org Tel: +91 80 4168 9195 /93
PRIVACY STATEMENT: By submitting this enrollment form you consent to the processing of your personal information by NEN solely as described in this statement. NEN will use personal information provided by you through this form to process your enrolment, correspond with you, and obtain your feedback in connection with any scheduled event, and to update our contact lists. In doing so, your information may be transferred throughout the NEN group worldwide and shared with third parties who will be providing other services. NEN will not sell or disclose your registration information to other third parties without your consent.

_______________________________________ Director or Principal (with institute/organization seal) Name: Date:

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