March 4-9, 2012
Owen Graduate School of Management
Vanderbilt University, Nashville, TN

Fill out the form below. Fields marked with * are required!

DISCOUNTED TUITION DEADLINE: February 1, 2012

• TBA cannot accept applications after February 13, 2012

Tuition
Payment in full is required with this application. Upon acceptance, TBA will notify the applicant by mail.

Standard Tuition (applications received after February 1, 2012):

TBA members/sponsors
$1,650
Nonmembers
$1,850

Any applicant withdrawing after February 1, but before February 13, will be refunded all fees except $250. There is no refund, with the exception of extenuating circumstances, if a registrant withdraws after February 13 or fails to attend the school. Substitutions are welcome. Refund requests must be submitted in writing to TBA.

Applicant Information

First Name*:
Last Name*:
Nickname*:
Title*:
Email Address*:
SS# (for tracking grades)*
Date of Birth:
Bank Name*:
Bank Address*:
City*:
State*:
Zip*:
Bank Phone*:

Housing*

TBA will make all hotel reservations. Hotel will accept requests for modifications or changes only through the TBA.

Background information is helpful when assigning housing:

Nonsmoker
Smoker

Male
Female
If you want a private room, click SINGLE. Until February 1, a $450 additional fee applies for a single room. After February 1, the fee increases to $600 and depends upon availability. The double room is included in the price of tuition. Double ($0)
Single ($600)
Roommate preference:
(Roommate requests are accommodated when possible. To request a specific roommate, write in his/her name. If you do not have a preference, write NO PREFERENCE and the school will assign a roommate.)

Professional Information:

Education Background*:
(Select highest level attended)		 High School
Some College
Associate Degree
Bachelor's Degree
Graduate Degree
Total Years of Banking Experience* Less than 1 year
1-5 years
6-10 years
11-20 years
Over 20 Years
Total Years of Consumer Lending Experience* Less than 1 year**
1-5 years**
6-10 years
11-20 years
Over 20 Years

** Applicants with less than 1 year of consumer lending experience or less than 5 years' general banking experience require written documentation from the CEO or the nominating officer supporting the request to waive this prerequisite.
Size of Bank's Loan Portfolio*

Under $1 million
$1-$5 million
$6-$10 million
$11-$50 million
$51-$100 million
Over $100 million
Size of Bank (Assets)*

Under $50 million
$51-$100 million
$101-$500 million
$501 million-$1 billion
Over $1 billion
Other

 


Education

High School/Prep:

Name of School
Year Graduated
Degree Received (if any)

College:

Name of School
Year Graduated
Degree Received (if any)
Major

Graduate School/Banking School:

Name of School
Year Graduated
Degree Received (if any)
Major

Other Relevant Training:

To satisfy admission requirements, you must indicate, in the area below, how you acquired a basic knowledge and understanding in the following subjects. If a basic knowledge is not indicated, your CEO or other authorized executive of your institution must submit a letter with this application explaining why these admission requirements should be waived.

 
Specify Courses or Educational Activities - One Box Must Be Checked
MONEY AND BANKING
Basic economic principles, the economy-how it works, the Federal Reserve system, the business of banking, monetarty policy and its impact on financial markets and banks, fiscal policy, and trends in banking.		 AIB
College Courses
Other (specify)
ANALYZING FINANCIAL STATEMENTS
Characteristics of financial statements and their analysis including the goals, methods, and tools of analysis, accounts receivable, inventories, balance sheets, profit and loss analysis, and their relationship to each other.		 AIB
College Courses
Other (specify)
CONSUMER CREDIT OR CONSUMER CREDIT ANALYSIS
Provides an overview of consumer credit operation, examining the role of consumer credit in overall banking operations. Also covers credit applications and investigation, credit decision considerations, interviewing, and documentation.		 AIB
College Courses
Other (specify)

I have read the admission requirements and desire to enroll in the school. In applying for admission, I understand that I will be expected to attend all classes, to prepare assigned work, and to abide in all respects to the standards established by the school. I agree to the code of ethics set forth by the school. I authorize the school to release my completion status to the management of my institution upon written request from my CEO or nominating officer.

Applicant's initials*: Date*:

Nominating Officer's initials*: Date*:

Nominating Officer's Name*: Title*:
(please type "Same as Above" if applicant is CEO or president)

This institution does not discriminate with regard to race, religion, gender, or age.


Payment in full is required on the next page