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1. Please indicate the program option you would like to apply to:
Full-time MBA (1 year) Full-time Executive MBA (1 year)
Part-time MBA (2 years) Part-time Executive MBA (2 years)
Full-time MBA in Sustainable Business (1.5 years) Full-time Executive MBA Sustainable Business (1.5 years)
Part-time MBA in Sustainable Business (2 years) Part-time Executive MBA Sustainable Business (2 years)
2. Entry date - Please indicate the semester to which you wish to enroll:
Fall - Winter Semester (September)
Spring - Summer Semester (February)
Mohammad Ali
First Name: _______________________ Middle Name: _______________ Family Name: _______________________
Ghaseminia
Male Female Mr. Email: _________________________________________________
Mr./Mrs./Ms.: ______
ali.ghaseminia@gmail.com
Feb 6th 1986 - Qom, Iran
Date and Place of Birth: _______________________________________________
No. 223, North Taghavi St, Modarres Blvd
Mailing Address: _______________________________________________ Post Code __________________________
3715115897
Qom, Iran
City & Country: ____________________________________________________________________________________
+982536661819 _______
Telephone: _______________________________ B30753070
Passport Number:__________________________
+989126526396
Mobile Number: ______________________________ Iranian
Nationality:_______________________________
Swiss Resident Permit: If you travel on a foreign passport, but have a Swiss Resident Permit or Visa please attach a copy of the document, even if it has expired.
Master of Science
______________________________________________
2012
_______________
Amirkabir University of Technology - Tehran
____________________________________
Bachelor of Science
______________________________________________
2009
_______________
Amirkabir University of Technology - Tehran
_____________________________________________
8. How did you hear about the Program? (Please indicate the source)
Event/Conference: _____________________________________________
Business School Lausanne reserves the right to change or modify in part or completely any course description and/or program in the interests of
all parties concerned. The place of legal venue for any dispute shall be Lausanne, Vaud, Switzerland.
Date: 6/13/2018
________________________________ Signature of applicant:
Ghaseminia
__________________________
Ghaseminia Date: 2018.06.13 22:55:51 +04'30'