Application for admission to the Biomedical University Residence Academic year 2021-2022 – Fondazione Collegio Universitario S. Caterina da Siena

I, the undersigned

Personal data

Surname: (required)

Name(s): (required)

Place of birth: (required)

Country of birth: (required)

Date of birth: (required)

Nationality: (required)

Sex: (required) MF

Tax code:

Address

Address: (required)

Postcode/ZIP code: (required)

Province/County/State:

Street/Road/Square, number: (required)

Phone number (landline):

Mobile phone number: (required)

E-mail address: (required)

REQUEST to be admitted to the Biomedical University Residence for the 2021-2022 academic year as:

Degree course I wish to study/am studying at Pavia:

Year of the course:

High School diploma:

Final mark:

For students after the first year, average mark (out of 30) obtained in examinations already taken:

Disciplines chosen for the selection:

Discipline 1:

Discipline 2:

Degree course I wish to study at Pavia:

Previous degree:

Bachelor’s degree obtained:

University that conferred the degree:

Final mark:

Degree course I am studying at Pavia:

Year of the course:

Average mark (out of 30) obtained in examinations already taken:

PhD programme I wish to do/am doing at Pavia:

Year of the course:

Degree course achieved:

University that conferred the degree:

Final mark:

Specialisation school/course that I wish to attend/am attending at Pavia

Year of the course:

Degree course achieved:

University that conferred the degree:

Final mark:

Master’s course I wish to do/am doing at Pavia:

Master’s course duration:

Degree course achieved:

University that conferred the degree:

Final mark:

To this end, I declare:

- that I have no prior criminal convictions and no pending charges;
- that I am of sound constitution, free from infectious diseases and as such do not require special care, diets or supervision;
- that I respect the Christian values of the college and accept and agree to observe its rules;
- that the above information is true and complete.

The Collegio Universitario S. Caterina da Siena Foundation uses the information supplied by students in order to assess and process applications for admission. If students are accepted, this information is entered into student files, in both electronic and paper format, containing their details (personal data, academic and financial information). Otherwise, their data will be stored and used only for internal statistical purposes. In any case, the data will be stored and used in accordance with EU Regulation no. 2016/679.

I authorise, pursuant to EU Regulation no. 2016/679, the processing of my personal data in the context of the purpose and procedure for which they were collected.

Date