Please attach

one passport-size

photograph here

CONFIDENTIAL

MASTER OF BUSINESS

ADMINISTRATION

APPLICATION FOR ADMISSION TO THE

MAASTRICHT SCHOOL OF MANAGEMENT

MBA OUTREACH PROGRAM

GENERAL AND STRATEGIC MANAGEMENT

ACADEMIC YEAR 2005 -2006

All sections in this application form must be completed in order to be considered for admission,

and must be returned together with the application fee of Dfl. 200,- (Euro 90,90) to the following address:

Maastricht School of Management (MSM)

MBA Department

P.O. Box 1203

6201 BE Maastricht

The Netherlands

1. Personal Data:个人资料

Mr. Mrs. Ms.

Last Name姓 First Name名 Middle Names

Home address家地址 Zip code区号

City/Country城市/国家

Telephone: Country code/city code/ Number Fax Number Email Address

电话

Date of Birth: Day/Month/Year Place of Birth Nationality

出生日期 出生地 国籍

2. Emergency Data紧急情况

Person to be notified通知人 Telephone

Address

City/ Country

3. Present Employer现单位

Name of Company/Institution单位名称

Address

City/ Country

Telephone Fax Number Email address

Present position (title)现任职务

Brief Description of Duties职责描述

4. Address for reply:

Home address / Business address (underline the address we should reply to)画线并填写地址

5. Academic Training:教育经历

College attended Dates of attendance Major field of Study(degree)

学校 入学日期 专业

College attended Dates of attendance Major field of Study(degree)

College attended Dates of attendance Major field of Study(degree)

College attended Dates of attendance Major field of Study(degree)

6. Proficiency in English英语水平

Oral:口语 Fair Good Excellent

Written: 书写 Fair Good Excellent

Toefl taken:托福 Yes No Gmat taken: Yes No

If yes, what was the score (attach copy): Toefl:……………… Gmat:………………..

7. Professional Experience:工作经历

List all other positions held during the last five years.

Company Position Dates employed

Company Position Dates employed

Company Position Dates employed

8. Profession Society Membership:有无参加社会团体，有，填写。

9. Professional Objectives for the MBA Study:学习目的

Please state your specific career objectives and what you expect to achieve from the MBA study.

10. Who recommended you to this Programme:

Please indicate how you heard about our programme.你是如何知道这个项目的

11. I herewith certify that the information given on this form is true:

Signature of Applicant签名 Place and Date地点/时间

以下不用填：

12. Scholarship, Fellowship and Grants:

This section only has to be completed if you are sponsored to attend the programme.

Name of Sponsor

Address

City/Country

Telephone Fax E-mail

Please indicate the period and total amount of support:

From Until Total amount in Dutch Guilders

Please tick off the check box(es) of the types of expenses that will be covered by the sponsor:

Tuition Travel Living Expenses Insurance

If others, please specify:

Signature of Sponsor Place and Date

Official Stamp: