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PRIMA Application Form

This document is an application form for an academic program for the 2011-2012 year. It requests personal information such as name, date of birth, contact details, education history, work experience, language skills, test scores, references, activities and interests, academic honors, and how the applicant plans to finance their education. It concludes with the applicant certifying the accuracy of the provided information and agreeing to the program's terms.

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Rash Madridsta
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© Attribution Non-Commercial (BY-NC)
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232 views6 pages

PRIMA Application Form

This document is an application form for an academic program for the 2011-2012 year. It requests personal information such as name, date of birth, contact details, education history, work experience, language skills, test scores, references, activities and interests, academic honors, and how the applicant plans to finance their education. It concludes with the applicant certifying the accuracy of the provided information and agreeing to the program's terms.

Uploaded by

Rash Madridsta
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Education and Culture

APPLICATION FORM FOR THE ACADEMIC YEAR 2011-2012


PERSONAL INFORMATION
Photo

1.

Full name:

last name

first name

fathers name

2.

Date of birth: Femal e: Permanent address:

day

month

year

Place of birth:

city

country

3. 4. 5.

Mal e:
number street city state country postal code

Reply address Daytime phone:

(if different from the permanent address)

6.

Country code

Area/city

Number

7. 8.

Evening phone:
Country code Area/city Number

Fax number:
Country code Area/city Number

9. 10.

e-mail address: Marital status: Single Marrie d Native Language Number of children

11.

Nationality:

Education and Culture

12.

Date of deposit of 50

13.

No of certificate of deposit:

Education and Culture

EDUCATION Institution and Country Subject Degree Study Period Graduation Date

FOREIGN LANGUAGES
Language Years of Study Diploma Date of Diploma

HAVE YOU TAKEN THE FOLLOWING TESTS?


GMAT: Date taken or to be taken: TOEFL: Date taken or to be taken: IELTS: Date taken or to be taken: Score: Score: Score:

RECOMMENDATION LETTERS (Please list below the people you have requested a
recommendation letter from)

Name Code 1. 2.

Title Tel.

Company/Institution

Address

City

Postal

Education and Culture

3. WORK EXPERIENCE (if any) Total duration of work experience: years Please list your work experience in chronological order starting from the most recent one WORK EXPERIENCE Company Country Period Title

MOST RECENT POSITIONS (you should complete the following starting from the most recent position)
COMPANY OR ORGANIZATION
NAME

STREET

TOWN TELEPHONE Country Code Area Code Number

POSTAL CODE FAX Country Code Area Code

COUNTRY

Number

SECTOR OF ACTIVITY

DEPARTMENT

COMPANY OR ORGANIZATION
NAME

STREET

Education and Culture TOWN COUNTRY TELEPHONE Country Code Area Code Number POSTAL CODE FAX Country Code Area Code Number

SECTOR OF ACTIVITY

DEPARTMENT

ACTIVITIES & INTERESTS Please list in order of importance to you the most important extracurricular activities you have been involved in (e.g. sports, student unions, politics, community activities, club memberships, editorships, hobbies, etc)

ACADEMIC HONORS OR AWARDS RECEIVED

FINANCING OF THE PARTICIPATION IN THE PROGRAMME How do you plan to finance your participation in the programme? Will you finance it yourself? No Will your company pay for your tuition fees? No Yes Yes Yes

Will your company pay you a salary while participating in the programme? No Will you be applying for scholarship? No Yes

Education and Culture

How and when did you first hear about AUEBs Programme in International Marketing?

Have you already submitted or do you plan to submit an application to another graduate programme? If yes, which one(s)?

Please specify your reasons for choosing the Programme in International Marketing

I certify that I have read the bulletin of the programme and I agree with the terms of participation in the specific graduate programme. I also certify that the information given above is complete and accurate.

Date Signature

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