MBA
MACOFIN II 2012 - 2013 ADMISSION FORM
MASTER IN BUSINESS ADMINISTRATION
27 Edition
TH
2017 / 2018 - ROME (Italy)
ID PHOTO
Personal Data
FIRST NAME
LAST NAME
DATE OF BIRTH (DD/MM/YYYY)
PLACE OF BIRTH
PASSPORT NUMBER / TAX CODE / C.F. NATIONALITY
ADDRESS
CITY POSTAL CODE
PHONE
MOBILE PHONE
E-MAIL
Current Employer
COMPANY NAME FIELD OF ACTIVITY
ADDRESS CITY
POSTAL CODE
SUPERVISOR'S NAME SUPERVISOR'S POSITION
PHONE FAX
E-MAIL
I DO NOT AUTHORISE THE MBA STAFF TO CONTACT MY CURRENT EMPLOYER
MBA 27th | 2017 - 2018 APPLICATION FORM
BACHELOR'S DEGREE
UNIVERSITY/INSTITUTION
LOCATION
FROM (MM/YYYY) TO (MM/YYYY) DEGREE RECEIVED
MASTER'S DEGREE PhD
UNIVERSITY/INSTITUTION
LOCATION
TO (MM/YYYY) DEGREE RECEIVED
Professional Experience
CURRENT POSITION
COMPANY
STARTING DATE (MM/YYYY)
MAIN RESPONSIBILITIES AND TASKS
PLEASE PROVIDE YOUR EMPLOYMENT HISTORY:
EMPLOYER POSITION
FROM (MM/YYYY) TO (MM/YYYY)
EMPLOYER POSITION
FROM (MM/YYYY) TO (MM/YYYY)
EMPLOYER POSITION
FROM (MM/YYYY) TO (MM/YYYY)
Languages
WRITTEN SPOKEN
ENGLISH sufficient good excellent sufficient good excellent
FRENCH sufficient good excellent sufficient good excellent
GERMAN sufficient good excellent sufficient good excellent
SPANISH sufficient good excellent sufficient good excellent
ITALIAN sufficient good excellent sufficient good excellent
OTHER sufficient good excellent sufficient good excellent
MBA 27th | 2017 - 2018 APPLICATION FORM
Tests
TOEFL NO YES DATE TOTAL SCORE
IELTS NO YES DATE TOTAL SCORE
GMAT NO YES DATE TOTAL SCORE
GRE NO YES DATE TOTAL SCORE
What are your personal interests and professional objectives?
Please tell us about a professional experience affected by personal weakness.
In terms of professional development, what are your expectations
from the MBA programme?
Please describe your significant experience abroad (of at least 3 consecutive months).
MBA 27th | 2017 - 2018 APPLICATION FORM
How did you hear about our programme?
WEBSITE SEARCH ENGINE DIRECT EMAIL
ONLINE PORTAL OR GUIDE SOCIAL NETWORK PRESS
FAIR (INDICATE THE CITY) FRIENDS/COLLEAGUES OTHER
References
NAME EMAIL
POSITION
ORGANISATION
NAME EMAIL
POSITION
ORGANISATION
APPLICATION FEE:
Bank Transfer should be made payable to: LUISS Guido Carli - Divisione LUISS Business School
BANK: Unicredit Banca di Roma
IBAN: IT17 H020 0805 0770 0040 0000 917
SWIFT: UNICRITM1C27
*Please indicate your name and the name of the chosen programme in the subject of the bank transfer.
SIGNATURE DATE
PLEASE FILL OUT IN CASE YOU ARE BEING SPONSORED BY A COMPANY.
COMPANY NAME
CONTACT PERSON EMAIL
SIGNATURE DATE
STAMP
CONTACTS
LUISS Business School
Villa Blanc - Via Nomentana, 216
00162 Rome (Italy)
t +39 06 85 225 577
t +39 06 85 222 306
[email protected]
www.mba.luiss.edu