Autocertificazione ai sensi del DPR n. 445/2000

Annex "B"

APPLICATION FORM

TO THE DOCTORAL SCHOOL ON ROBOTICS, NEUROSCIENCES AND NANOTECHNOLOGIES

IN COLLABORATION WITH THE ITALIAN INSTITUTE OF TECHNOLOGY

Deadline October 1st, 2007 (postmarked)

Please use the enclosed form and provide all requested information

Al Magnifico Rettore

dell’Università degli Studi di Genova

Via Balbi, 5

16126 GENOVA

The undersigned (Family Name and First Name) ______

Place of birth ______Country of Birth______Date of Birth______

County of Citizenship ______

Country of Residency______

City: ______Street______Postal Code______

Codice Fiscale (Italian residents only)[1] ______

Gender M F

Address for official communication regarding this application (if different from above):

City: ______Street______Postal Code______

Phone ______Cellular Phone______

E-Mail ______

PRESENTS THIS APPLICATION

to the DoctoralSchoolon Robotics, Neurosciences and Nanotechnologies in collaboration with the IIT Foundation for the academic year 2007-2008

TO THIS END DECLARES

Pursuant to art. 46 of the Presidential Decree No. 445 of December 2000, regarding substituting certification:

a)To be of ______Citizenship;

b)To have obtained the Italian degree in ______at (Institution) ______with marks _____on (date) ______;

Or

(for non-Italian degrees already declared equivalent to the Italian “Laurea Specialistica”)

To have obtained the degree in ______at (Foreign Institution)_____with marks_____ on______already declared equivalent to the degree called for by the Italian system with measure No. ______of ______

Or

(for non-Italian degrees for which does not exist a declaration of equivalence to the Italian “Laurea Specialistica”)

That has obtained the degree in ______at (Foreign Institution)_____with marks_____ on______and asks the Board of Professors of the Doctorate to evaluate and to declare the equivalence of the degree to the Italian Laurea.

Or

In case I have not obtained yet the laurea degree or equivalent at the time of submitting that application, I commit to give proof of it within November9th, 2007, according to the regulations in the call

c)To have a (sufficient/good/excellent) knowledge of the English language;

d)To apply for the following Research Theme ______(see Annex A);

e)To intend to enrol to the doctoral program on a full-time basis;

f)To promptly inform the University in case of change of address in relation to the present application;

g)To be aware of the criminal sanctions provided for by article 76 of the Presidential Decree No. 445 of December 28, 2000 and by any dispositions of the Italian criminal code in the event of false information in mendacious declarations and producing forged documents.

It is necessary to attach on this application a photocopy of passport or a valid identification document in the country of citizenship

I will send, by the 1st October 2007,the following documents at Dipartimento di Informatica, Sistemistica e Telematica (DIST) – Viale Francesco Causa 13 – 16145 Genova, Italy (Attn. Prof. Giulio SANDINI):

a)Signed list of documents send with a copy of passport or a valid identification document in the country of citizenship;

b)Curriculum vitae et studiorum with all titles considered relevant;

c)(In case the candidate presents degrees not obtained in Italy) documents supporting the request for equivalence or demonstrating that such equivalence has been already declared.

d)Copy of the thesis dissertation (if mandatory to obtain the degree) and of any other publication that may be considered relevant;

e)List the courses attended with individual marks

f)Statement of research (max 20.000 characters). The statement of research should be related to the Research Theme declared by the candidate in the application (and selected from Annex A) and should contain the following details:

Title of the research;

State of the art in the field and bibliography;

Objectives and results expected;

(if relevant) experimental methods and data analysis.

g)At least one recommendation letter.

Date and Place ______

Signature

______

Candidates will not be personally informed about the outcome. Results will be published in the terms of article 5 of the call.

MAILING INSTRUCTIONS

  1. The signed application form and a photocopy of passport (or valid identification document) haveto be sent, by October 1, 2007 (date of mailing must be marked on the parcel) to:

Università degli Studi di Genova

Servizio Alta Formazione e Mobilità Internazionale

Settore VII

Via Bensa, 1 (2° piano)

16124 Genova

Ref: “Concorso per ammissione al XXII ciclo del Dottorato di Ricerca”

  1. All other documents must be sent, by October 1, 2007(date of mailing must be marked on the parcel) to:

Dipartimento di Informatica, Sistemistica e Telematica

Università degli Studi di Genova

Attn. Prof. Giulio Sandini

Viale Francesco Causa, 13

16145 Genova

Ref: “Concorso per ammissione al XXII ciclo del Dottorato di Ricerca”

1

[1] This is the equivalent of the social security number and is given to all Italian Citizens and to foreign citizens working, also temporarily, in Italy.