FLOR SCHOLARSHIP APPLICATION FORM

TO THE RECTOR
UNIVERSITA' POLITECNICA DELLE MARCHE

The undersigned __________________________________________________ asks to be admitted to the selection for the granting of scholarships to International students admitted to the Master's Degree  in "ENVIRONMENTAL ENGINEERING" of the Università Politecnica delle Marche, academic year 2017/2018.
To this end, in accordance with Articles. 46 and 47 of Presidential Decree n. 445/2000, and aware that whoever makes false statements or uses false documents is punishable under the Italian Penal Code and the specific laws, declare under his/her own responsibility the following:
PERSONAL DATA
Surname…………………………………………………………	Name …………………………………………………………
Place of birth ………………………………………………	         	Date of birth ……………………………………………
Citizenship …………………………………………………
RESIDENCE
Country ………………………………………………   	            Address……………………………
Postal Code ……………                                    	   	City……………………….                                                
Tel.…………………………….                                  	Cell. ……………………………… 
e-mail ………………………………………………
DOMICILE (if different from residence)
Address…………………………………………………		Postal Code ……………………….
City ……………………….                                                Tel. …………………………………….
ACADEMIC POSITION 
Successfully admitted to the first year of the Master’s Degree in " ENVIRONMENTAL ENGINEERING " by the Admission Committee.
ATTACHMENTS: 
Copy of passport or other identity document
By signing this application, the undersigned declares to be aware that these data will be used for the purposes of this selection and management, within and for the institutional purposes of the Public Administration (Legislative Decree 30.06.2003 n. 196).
Read, confirmed and signed.				            The undersigned
………………………………………………				…………………………………………………………
Place and date						                            (Full signature)