CONFIDENCIAL.doc

CONFIDENCIAL 国立南澳大学 International Graduate School of Business 商学院国际研究生分院 Application form for Admission to: Master of Business Administration(MBA) 工商管理硕士课程入学申请表 Closing date:（申请截止日期） 1.PERSONAL DETAILS (Please print clearly and tick where applicable) 个人资料(请在直线上填写) UniSA ID Number (if available): Title (Please circle one): Mr. / Mrs. / Miss / Ms /Other 南澳大学学号 (如有) 称呼(请圈选): 先生/太太/小姐/女士/其他 Family Name (as appears on your passport) Given Names (as appear on your passport) 姓 (依照护照) 名(依照护照) Gender 性別 □ Male 男 □ Female 女 Date of Birth 生日____________/____________/____________ (Date日/Month月/Year年) Country of Birth: 出生国家: Citizenship: 国籍: Do you want your Family name to appear first on all official UniSA documents eg.transcripts and parchments? 在所有南澳大学的相关正式文件上(如成绩单和证书)，您是否希望您的姓放在名字的前面？ □ Yes □ 是 □ No □ 否 Mailing Address (Home): 邮寄地址(家庭): Mailing Address (Business): 邮寄地址(公司): Telephone Numbers 家庭电话: (Business)公司电话: (Mobile) 移动电话: Fax Number (Home) 家庭传真: (Business)公司传真: E-Mail Address (Business)公司电子信箱: (Other, if applicable): 其他，如有: Please send all correspondence to 所有课程资料请寄到: □ Home □ 家庭 □ Business □ 公司 2.EDUCATION DETAILS (please print clearly) 教育程度（请填写清楚） List all tertiary education/secondary education or post-secondary courses attempted and attach Official Transcripts. 请列出所有已完成或在读的中高等教育的课程，并附上学位证书和成绩单 Name of Institution 学校名称 Country of Institution 就读国家 Name of Qualification 学历资格 Language of instruction 授课语言 Completed (Circle one) 已修完(请选择) Transcript attached (circle one) 附上成绩单 (请选择) (a) 英文: 中文 Yes/No 是/否 Yes/No 是/否 (b) 英文: 中文 Yes/No 是/否 Yes/No 是/否 (c) 英文: 中文 Yes/No 是/否 Yes/No 是/否 (d) 英文: 中文 Yes/No 是/否 Yes/No 是/否 Have you ever been precluded from further study at this University or any other tertiary insti