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
mba@luiss.it
www.mba.luiss.edu