AY 2020-2021 Application Form for Incoming Students Posted on 20 Aprile 2020 by folivi AY 2020-2021 Application Form for Incoming Students If you are human, leave this field blank. APPLICATION (To fill the form please use only English alphabet letters with no accents). Use all your names and surnames exactly as they are write in your passport/id Family Name/s - exactly as your Passport/ID * Name/s - exactly as your Passport/ID * Email * ID Card – Passport * NumberNumber ID Card – Passport - dd/mm/yyyy * date of expiredate of expire Sex * M F Nationality * Date of Birth - dd/mm/yyyy * Place of Birth - City * Place of Birth - Country * Mobile Number with international prefix * + International prefix/mobile number+ International prefix/mobile number International Prefix Emergency Number * Emergency NumberEmergency Number Home Number Period of Stay * First Semester Second Semester Whole Year Duration of stay - total months (in Number) * Duration of stay - FROM - Day/Month/Year * Duration of stay - TO - Day/Month/Year * Programme * Double-Degree Erasmus + KA107 Erasmus+ for study Erasmus+ for traineeship Globus for study Globus for traineeship Visiting Student Research Asia Echange Level * Bachelor Master phd - Doctoral Country of home University * Name of home University * Erasmus code of home university * Faculty/Department * ISCED code (ask to your University) * Departmental/Institutional Coordinator of home University Name Tel - e-mail * MEDICAL INSURANCE You should send a copy of the medical insurance that you have I have the European Health Card ? * No yes Do you have a disability/special needs (including dyslexia)/medical condition? * No Yes, Please state details of this disability/special need/medical condition:Yes, Please state details of this disability/special need/medical condition: If you require any special assistance as a consequence of condition stated above, please outline there LANGUAGE COMPETENCE Do you wish to attend an Italian language course? * Yes No Notes Photo and ID Check the box and upload the documents(Not more than 8 mbyte are allowed) * Official Document type Photo ID Card or Passport EHIC - European Health Insurance Card - (if possessed) upload here your ID card/passport AND the photo * Trascina qui il tuo file o fai clic per caricarlo Scegli file Dimensioni massime caricamento: 9.8MB. UPLOAD LIMIT: 9.8 MB.