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APPLICATION FORM

POLITECNICO DI MILANOSpecializing Master ( MASTER UNIVERSITARI)

Academic Year .

Specializing Master in:

"."

Level : 1st 2ndDR n./.

(document number of the specializing Master / year)

STUDENTS PERSONAL DATA

Family Name

First NameSexM F

Date of Birth //(mm/dd/yyyy)Place of Birth _______________________________

Citizenship(s)____________________________________________________________

Current address (Valid until)//(mm/dd/yyyy)street/square______________________________________________________n._____________

Location ________________________________________________________________________

Post Code ________________

Country_____________________________

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Permanent address (if different)

street/square______________________________________________________n.____________

Location _______________________________________________________________________

Zip Code ________________Country_____________________________

Phone include international dialling code ___________________________________________

Mobileinclude international dialling code ____________________________________________

Faxinclude international dialling code _______________________________________________

E-mailaddress(write one letter or symbol in each box)

ACADEMIC BACKGROUND

Degree 3 years degree 4 years degree 5 years degree

Diploma/Degree qualification title_____________________________________________________________________________

Diploma/Degree Date_____________________________________________________________________________

Start date (month-year) ___________________ End (month-year) _______________________

Name of University ______________________________________________________________

City ________________________________________ Country _________________________

Final marks (please indicate grading system; e.g. 78/100, GPA (4.25/5) , etc) ______________________________

Title of thesis______________________________________________________________________________

Diploma/Degree qualification title(please indicate Bachelor or Master in)

__________________________________________________________________________________________________________

Diploma/Degree Date______________________________________________________________________________

Start date (month-year) ______________________ End (month-year) ______________________

Courses and educational seminars______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

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2. Role ___________________________________________________________________________

Sector/Industry_____________________________________________________________________ Where____________________________________________________________________________

From_____________________________to______________________________________________

Activities___________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________

3. Role ___________________________________________________________________________

Sector/Industry_____________________________________________________________________ Where____________________________________________________________________________

From_____________________________to______________________________________________

Activities__________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Non-EU students (whose country of residence is not Italy) must submit this application form and thedocuments to evaluate the educational background, directly to the Italian Embassy or Consulate incharge of issuing the visa, within the terms required for enrolment.It is necessary to submit to the Italian Embassy or Consulate:

1. This application form2. Original copy of the degree obtained

Politecnico di MilanoServizio Offerta Formativa Post LaureaCorporate & Continuing EducationP.zza Leonardo da Vinci 32 . Padiglione Nord20133 MilanoFax +39/02/23992565Tel. +39/02/23992158

Only for Non-EU citizens residing in Italy

A copy of residence permit or residence card must be included.They can personally submit the above listed documentation.

All documents written in a foreign language must be translated either in Italian or English.

Date _______________

Applicants Signature____________________________________

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GENERAL QUESTIONS

HOW DID YOU KNOW ABOUT THIS MASTER PROGRAMME?Please, specify otherwise your application will not be taken into consideration:

Article (please specify in which newspaper, magazine, etc.)___________________________________________

Internet (please specify in which website) __________________________________________________________

School/University (please specify in which one)_____________________________________________________

International Fear (please specify which)___________________________________________________________

From poster (specify where) _____________________________________________________________________

Mailing list (please specify by whom) _____________________________________________________________

Italian Embassy or Consulate (please specify which one and where)____________________________________

People suggestion (please specify whether a friend, teacher, etc.)______________________________________

Brochure of the Master (specify from whom)________________________________________________________

Other (please specify)_________________________________________________________________________