Attachment n. 2bis (integral part of the announcement of comparative evaluation for admission to the IUAV School of doctorate studies for the academic year 2017/18)

APPLICATION FORM (to be used only by candidates applying to the places reserved for holders of scholarships granted by foreign universities, foreign institutions or international mobility programs)

To the Rector of the Università IUAV di Venezia

Santa Croce 191

30135Venezia

Italy

I, the undersigned______

Italian Tax Codecodicefiscale(if available)______

Born in (place of birth) ______Country of birth______

Date of birth______

City of residence______Provinceof Italyor foreign country______

Postcode / ZIP______

Street name and number______

Phone numbers ______e-mail______

having read the announcement for the comparative evaluation for admission to the research doctorate courses for the academic year 2017/18 and aware that should false or misleading information be given in the present declaration, penal sanctions will be applied as specified in the DPR of 28 December 2000 n.445, Article 76;

having acknowledged that the data contained in the present declaration will be used only for the purposes inherent to the institutional tasks of the administrations involved in the procedure as specified in the legislative decree n. 196/2003,

request to participate in the comparative evaluation to be admitted to the IUAV School of Doctorate Studies on the research doctorate course “Architecture, City and Design” – places reserved for holders of scholarships granted by foreign universities, foreign institutions or international mobility programs

I hereby declare:

a) to be a citizen of ______;

b) toundertake, should I be admitted to the School, to attend the doctorate course in the manner established by the educational board;

c) to inform the IUAV as soon as possible should I change my place of residence or contact address;

d) that I have the degree in:

______

conferred on (date) ______with the result ______/_______

at the University of ______

(name and legal status of the university, town and country, university website):

official language of teaching: ______

degree level: ______

duration: ______

admission requirements: ______

admission to further studies: ______

professional status conferred: ______

other useful information: ______

Only for candidates residing abroad or temporarily living abroad for work or study reasons
I the undersigned ______
request the option of a video conferencing interview via Skype, if admitted to the oral exam.
My Skype address is ______
I am aware that failure to communicate any change of the abovementioned address, to be online on the date and time established, to show the identity document will lead to exclusion from the selection procedure.

I enclose the following documents:

  • photocopy of a valid identity card;
  • certificate attesting the scholarship is granted by a foreign university, government, other private/public institution or international mobility programmes;
  • degree certification (in Italian or in English);
  • certificated list of the exams (in Italian or in English);
  • curriculum vitae;
  • letter providing reasons for participating in the course
  • … (list others)

Date ______Signature ______

(failure to signthis document will render it null and void)