The Ohio State University / Ohio MSDC Executive Education Program Application

APPLICANT INFORMATION
SalutationFirst NameM.I.Last Name
Gender
Business EmailPersonal Email
Business PhoneMobil Phone
Website
Minority Status
CONTACT INFORMATION
Business Physical Address
Business Physical CityStateZip
ASSISTANT CONTACT INFORMATION (if applicable)
First NameLast Name
PhoneEmail
Copy assistant on program related communications
BUSINESS INFORMATION AND PROFESSIONAL EXPERIENCE
Business NameTitle
Please choose from the drop down menu your NAICS primary code:
Enter your NAICS secondary code and title
Please provide a brief description of your company:
Year Business Began
Who are your major customers?
Certifications
Please specify which Council affiliates and/or government/state agencies your company is certified by:
Number of full-time employees
Number of part-time employees
Past and projected sales
201520162017
Percentage of company that you own:
Percentage of revenues that are:
Public SectorPrivate Sector
What percentage of your business is:
LocalRegionalNationalInternational
Do you have a formal business plan?
List honors, awards, or other recognition you (or your company) have received. Please include granting organization and year of honor/award.
Describe in 100 words or less, a current problem or opportunity facing your business that would benefit from an external perspective:
Additional information you feel we should know about you:
PROGRAM COST
The cost of the program is $5000.00. This amount must be paid in full, fourteen days prior to the start of the program. If you are the recipient of a scholarship from a corporation, foundation or non-profit organization, please inform your supporter that a letter of support for your tuition must be received fourteen days prior to the start of the program.
Plan to cover the $5,000
Applying for Bank of America Scholarship
Sponsored by a corporate member, foundation or non-profit
If you are not sponored by a company please enter "NA" in the below fields
Sponsors First NameLast Name
Company
PhoneEmail
   - denotes required fields