/ Application formfor enrolment
at the PhD programme
a.y. 2017/18
Ufficio Offerta Formativa / Pag 1 di 3

To the Rector of the Tuscia University Offerta Formativa Office

Via S. Maria in Gradi n. 4

01100 Viterbo (I)

I, the undersigned,

______

SurnameName

______

Place and date of birth Province and Country

______

Current address

______

Place of domicile in Italy (if different from the permanent residence - it can be provided after arrival in Italy)

______

Mobile phone number e-mail

being admitted to the Ph.D. Programme, XXXIII cycle, a.y. 2017/18,in______, at Tuscia University, Viterbo (Italy), as for the ranking list published on the University web site

request to be enrolled in the first year of the aforementioned PhD programme.

I understand that any false declarations will be punished by law following art. 76 of D.P.R. of 28 December 2000 no. 445. The Tuscia University will undertake checks, random or otherwise, to verify the truth of the statements and declarations following articles 71, 75 and 76 of the same law.

/ Application formfor enrolment
at the PhD programme
a.y. 2017/18
Ufficio Offerta Formativa / Pag. 2 di 3

I hereby declare

 to have achieved my qualification (Master’s degree or equivalent university degree) at the University indicated at the time of pre-enrolment;

 tohave achieved the qualification on ______with the following mark/grade ______Degree class ______(Italian university titles only) at the University ______;

 to have not enrolled at other universities or other higher education establishments, at other Departments or Schools of the University of Tuscia or for other degree courses in the same Departments/school at the same time as this enrolment;

 in 2018 his/her total annual gross personal income will not exceed €14,000;

  • I  am  am not (please tick the pertinent box) a public servant, as per art.2 of the Law 13/08/84, no. 476;
  • I  am  am not (please tick the pertinent box) a private company employee or other type of worker (please specif) ______;

I also undertake that I will follow all the rules and regulations laid down by law, as well as will follow the Statute of the University of Tuscia and internal regulations available on the University’s web pages (Normativa), among which “Regulations concerning Ph.D. research programmes”.

I attach:

  1. a front and back photocopy of an identity document that conforms to the laws in force. Identification of the student will be based on the presentation of this document (Identity Card, Passport, etc.);
  2. the copy of the enrolment fees payment receipt (regional tax for the right to University Education and stamp duty). The payment must be by bank transfer in the following way:
    Beneficiary: Università degli Studi della Tuscia

Amount: € 156,00

Bank: Banca Intesa Sanpaolo

SWIFT code: BCITITMM

IBAN code: J030 6914 5001 0000 0300 002

  1. copy of the scholarship acceptance form;
  2. the form with bank account details;
  3. two recent passport-size photos.

/ Application formfor enrolment
at the PhD programme
a.y. 2017/18
Ufficio Offerta Formativa / Pag. 3 di 3

Data protection in compliance with Art.13 of Legislative Decree no. 196/2003:

a) personal information provided by the student is needed by the University to allow performance of its institutional functions

b) the University will access this information exclusively for the above mentioned purpose;

c) the appointed official for treatment of personal data is the University of Tuscia - via S. Maria in Gradi n. 4 - 01100 Viterbo in the person of its legal representative,the Rector.

Date ______

(Student’s signature)