Application form a.a. 2006/2007

goals
structure
specializations
courses
governing bodies
events

information
application form

intranet

italian edition

Note: please do not use inverted commas (") when filling in the form.

Address
This address will be used for all subsequent communication.
First Name	Last Name
Street and Number
Posta Code	City
Country	Phone (with full code)
Fax (with full code)	Cellular (with full code)
E-Mail Address (only one)

Candidate Profile Information
All information given will be treated in the strictest confidentiality.
Date of Birth	Nationality
Faculty	University
Last Degree	Specialty
Graduation Date	Mark or Average
Final Dissertation Title
Current Profession (if it exists)	Baccalauréat Nature
Baccalauréat Year	Mark or Class

High School Studies (year by year)
Please specify: Year, Level, Institution, Result and Average

Professional Experience

Other Information

Specialization

Select according to a preference order:

Multichannel Communication : Content Design
Multichannel Communication : Management and Technology

I declare on my honour the correctness of all information mentioned above and I undertake to present the originals of diplomas and certificates of marks if my candidature is selected by the scientific committee. Any erroneous mention entails the cancellation of my candidature.

This application form has to be received by November 6, 2006.
Each application form with incomplete information will be not be examined

Application form a.a. 2006/2007

Address

Candidate Profile Information

Specialization