DIVISIONE RELAZIONI INTERNAZIONALI DOUBLE DEGREE PROGRAMMES APPLICATION FORM 2015/2016 Foto (obbligatoria) 1. PERSONAL INFORMATION _____________________________ ___________________________ Last name First name _____________________________ ___________________________ Unisi email (@student.unisi.it) Private email ________________________________________________________________________________ Address _________________ ____________________________ _____________________ Postal Code City Country _____________________________ ___________________________________________________ Citizenship Place and date of birth ________________________ _______________________________________ Phone number Mobile number ________________________________________________________________________________ 2. EDUCATIONAL BACKGROUND ______________________________ ___________________________ ______________________ Name of Bachelor’s degree University Year completed Grade Point Average (GPA) and Final Grade from Bachelor’s Degree: _____________ _____________ ________________________________________________________________________________ __________________________ ___________ ________ ________________________________ Name of MSc Degree Year Credits Grade Point Average (GPA) I have previously been on exchange at: _____________________________ ________________________ __________________________ Institution Country Time period I received an ERASMUS scholarship from UNISI or another EU institution for the year ___________________ Double Degree Programmes 2015/2016 Application Form Page 1 of 3 DIVISIONE RELAZIONI INTERNAZIONALI 3. CHOICE OF DOUBLE DEGREE PROGRAMME Accounting and Management Finance Economics EBS, Germany Uppsala Universitet University of Ljubljana, Slovenia Romanian-American University, Bucarest ________________________________________________________________________________ 4. ENGLISH LANGUAGE PROFICIENCY TOEFL (iBT Total 0-120): Test score Cambridge First Certificate of English: Grade Score Other Test: Test score ________________________________________________________________________________ 5. EMERGENCY CONTACT ____________________________________ Full name ____________________________________ Address ____________________________________ Postal code Double Degree Programmes 2015/2016 Application Form _______________________________________ Email _______________________________________ City _______________________________________ Country Page 2 of 3 DIVISIONE RELAZIONI INTERNAZIONALI ________________________________________________________________________________ 6. LIST OF ENCLOSURES The following documents must be enclosed with your application: • A motivational essay (approximately one page in English) • Your CV/ resume in English • A copy of your Bachelor’s degree diploma or self- certification • Transcript of records of Laurea Magistrale or self certification • English language competence certificate Enclosed 7. SIGNATURES I confirm that the above information is correct. Date __________________________ Signature ___________________________________________________ With my signature I hereby authorize University of Siena to submit this application or any relevant parts of it to be used for the consideration of organizations offering scholarship for study abroad. Date Signature __________________________ ___________________________________________________ Disclaimer I hereby confirm my understanding of the fact that University of Siena has no legal responsibility or liability for me while abroad. I further confirm that I will purchase the necessary insurance coverage for my period of study abroad. Date Signature __________________________ ___________________________________________________ Double Degree Programmes 2015/2016 Application Form Page 3 of 3