Professional Documents
Culture Documents
Intake
www.genovasi.my
PERSONAL INFORMATION
Passport
Picture
Male
Female
dd
mm
yyyy Place of Birth ________________________
Birthdate ____/____/____
CONTACT INFORMATION
Mailing Address ________________________________________________________________
______________________________________________________________________________
City/Town ______________ Postal Code ______________ State _____________________
Telephone _______________ Mobile _______________ Email _______________________
EDUCATION BACKGROUND
Field(s) of Study _______________________________________________________________
(e.g. Law, Systems Engineering, etc.)
Currently Studying
Yes
No
Name of University/College
Year of Graduation
______________________________________ ______________________________________
______________________________________ ______________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Memberships
Please list any clubs, academic and/or social associations you are a member of
______________________________________________________________________________________________________
______________________________________________________________________________________________________
Motivation
Please describe in a short and plausible manner why you would like to study at Genovasi. What do you personally
expect from the programme for your professional future?
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CURRICULUM VITAE
Please include a copy of your curriculum vitae (maximum of 2 pages) as part of the application
form.
CLASS SCHEDULE
The following is our class schedule. Please mark () your preferred choice:
No
1
2
3
4
Class
3A
3B
3C
3D
Class
Day
1
Monday
Tuesday
Friday
Saturday
Class
Day
2
Thursday
Friday
Saturday
Sunday
Class
Hours
9am-5pm
9am-5pm
9am-5pm
9am-5pm
Preference
[
]
[
]
[
]
[
]
*Please be informed that classes are subject to the number of students registered.
ADDITIONAL INFORMATION
How did you hear about Genovasi?
Website
Youtube
Newspaper
Magazine
Friends
T-PROFILE
Looking outside of one's own (academic) box is part of the Innovation Ambassador Development
Programme. Since innovative solutions to complex problems require several disciplines, it is
beneficial for problem solvers to speak different "languages" to ease understanding and allow
for varying points of view. It order for us to attain a better insight not only into your
professional and academic experience, but also your interfacing expertise, inter-disciplinary
skills and projects, we ask you to please complete the T-Profile on the next page.
There is only one rule: The vertical bar must be filled with relevant information about your
academic studies (analytical) and in the horizontal bar, you can map competencies and
activities that transcend or do not relate directly to your field of study (creativity). How and in
what format you do this - as a text, drawing, diagram or photograph is completely up to you.
DECLARATION
I declare that the information provided in the application form is true and correct and that I
have filled in all fields in the application form.
Signature ____________________________________________
Date ________________
SUBMISSION
To submit your application form, you can either: