APPLICATION FORM

POLITECNICO DI MILANO Specializing Master ( MASTER UNIVERSITARI)

Academic Year .

Specializing Master in:

"."

Level : 1st

2nd

DR n./.
(document number of the specializing Master / year)
STUDENTS PERSONAL DATA
Family Name

First Name

Sex

MF

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_____________________________

Permanent address (if different)

street/square______________________________________________________n.____________
Location _______________________________________________________________________
Zip Code ________________
Country_____________________________
Phone include international dialling code ___________________________________________
Mobile include international dialling code ____________________________________________
Fax include international dialling code _______________________________________________
E-mail address (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
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Published Works
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

High School
_________________________________________________________________________________
City ________________________Country __________________________
Final marks (please indicate grading system; e.g. 78/100, GPA (4.25/5), etc) __________________________________
Further titles

1. Institution _______________________________________________________________________
Title______________________________________________________________________________
Year of achievement _____________
Final marks (please indicate grading system; e.g. 78/100, GPA (4.25/5), etc) __________________________________

2. Institution _______________________________________________________________________
Title______________________________________________________________________________
Year of achievement _____________
Final marks (please indicate grading system; e.g. 78/100, GPA (4.25/5), etc) __________________________________
3. Institution _______________________________________________________________________
Title______________________________________________________________________________
Year of achievement _____________
Final marks (please indicate grading system; e.g. 78/100, GPA (4.25/5), etc) __________________________________

EXPERIENCE
In relation to the subject of Specializing Master (starting from the most recent)
1. Role ___________________________________________________________________________
Sector/Industry_____________________________________________________________________
Where____________________________________________________________________________
From_____________________________to______________________________________________
Activities__________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

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 the
documents to evaluate the educational background, directly to the Italian Embassy or Consulate in
charge of issuing the visa, within the terms required for enrolment.
It is necessary to submit to the Italian Embassy or Consulate:
1. This application form
2. Original copy of the degree obtained
Politecnico di Milano
Servizio Offerta Formativa Post Laurea
Corporate & Continuing Education
P.zza Leonardo da Vinci 32 . Padiglione Nord
20133 Milano
Fax +39/02/23992565
Tel. +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____________________________________

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)_________________________________________________________________________