Building Technology

FORM A (To be filled in CAPITAL LETTERS)

PRE-ENROLLMENT APPLICATION FORM FOR NON-EU CITIZENS LIVING OUTSIDE ITALY

Academic Year ………………………………....

To the Rector of the University of ……………………………………………………………………………………………………………………...… (please, specify the official name of the University) The undersigned: Surname (max 2 words):…………………………………………….…...………………………………………….... (for married women: please indicate your maiden name, first) Name (max 2 words):………………………………. ………………………………………………………………… Born on………………...........................in…………………………………………………………………………….. (City) (Country) ………………………………………………………………………………………………………......……M / F...... (citizenship) (sex) Address……………………………………………………………………………………............………………….. (Street name and number) (City and ZIP Code) ……………………………………………………………………………………………………………………………… (Country) (Telephone number) (e-mail address)

In possession of: (Please cross out the option, which does not apply) Final school leaving qualification achieved/attendance details of the last year of High School “………………………………………………………………….…………………………………………………………” (Please specify the name of the qualification in the original language) University-level qualification/post-secondary qualification achieved at a non-academic Institution, which entitles the student to access the following level of academic education. The title in question has been achieved after High School completion and after no less than 12 years of global schooling. (Please cross out the option, which does not apply)

“………………………………………………………………….…………………………………………………………” (Please specify the name of the qualification in the original language)

Final mark indicated on the qualification………………...........…………………………………………………………... Issuing institution/Name of the Institution, where the student is attending in the last year of school (Please cross out the option, which does not apply) “…………………………………………………………………………………………………………………………….” Foreign education system of reference (1)...