Al Magnifico Rettore dell’Università degli studi di Genova

a.a. 20    /20

__ l __ sottoscritt __ ______________________________________________________________ nat __ a _____________________________________________________________ Prov. _____ il __________ cittadinanza _______________________ codice fiscale ______________________ residente a _________________________________________________________ Prov. ______ Via/Piazza _____________________________________________ n° ________ C.a.p. ________ Telefono ________________________________ Cellulare _______________________________
E-mail _________________________________________________________________________
CHIEDE
di iscriversi alle seguenti attività formative:

Codice e Denominazione	Crediti	Dipartimento	
1.				
2.				
3.				
4.				
5.				

A tal fine dichiara quanto segue:
•	l’iscrizione è finalizzata a conseguire crediti utili all’accesso per le seguenti classi di    insegnamento ai sensi del DPR 19/2016 ________________________________________
•	l’iscrizione è finalizzata a conseguire crediti utili al riconoscimento dei 24 cfu (DM 616/2017) presso questo Ateneo e conferma di aver preso visione delle delibere di massima del Comitato di Gestione.
•	di essere in possesso del seguente diploma di scuola secondaria superiore o altro titolo di studio conseguito all’estero, valido per l’iscrizione all’Università:
Titolo di studio __________________________________________________________________ Stato __________________________ anno scolastico _____ / _____ voto di maturità ____ / ____ presso l’Istituto scolastico _________________________________________________________ Comune ________________________________ Provincia _______________________________

Allega:
•	Ricevuta versamenti tasse e contributi (il pagamento della tassa di iscrizione è previsto per ogni corso);
•	Fotocopia di valido documento di identità personale;
•	Una fotografia formato tessera.

Genova, _________________________		Firma _________________________________ 
To the Rector of the University of Genova, Italy

a.y. 20    /20

The undersigned Ms/Mrs/Mr (Name Surname)______________________ _________________
____________________________________________________________________________
born in (City and Country) __________________________________ on (dd/mm/yyyy) _______
Citizenship _______________________ Fiscal code (if available) ________________________
Resident in (City; Province, Country)_______________________________________________
Street/Square __________________________________ n° ________ Zip Code ____________ 
Telephone number (with Country Code) _____________________________________________ 
E-mail address __________________________________________________________________
ID document type (Passport, ID card)________________________________________________
ID document Issued by ___________________________________________________________
ID document number _____________________________________________________________

APPLIES FOR
being enrolled at the University of Genova in the following Teaching Modules:
(List of available BSc and MSc Courses and related modules is available at: websiteaddress

Module Name and Module Code	Credits	Department	
1.				
2.				
3.				
4.				
5.				

The undersigned also declares that:
•	The present enrolling is aimed at the award of European University Credits (EC) useful for accessing BSc or MSc courses at the University of Genova (Italian law DPR 19/2016) 
•	To possess the following Diploma (Secondary School), awarded after an overall number School years equal to: __________
Diploma Name:__ _____________________________________________________________ 
Year of issue ___________________ Final mark/Grade of Diploma (grade/maxgrade) ____ / ____ 
Teaching Institution___________________________________________________ 
City and Province__________________________ Country_______________________________
•	To possess the following Degree Title (University), awarded after a number University years equal to: __________

Degree type (BSc or MSc):__ __________________________________________________ 
Degree Name:__ __________________________________________________
Year of issue __________________ Final mark/Grade of Degree (grade/maxgrade)  ____ / ____ 
University___________________________________________________ 
City and Province__________________________ Country_______________________________

Attachments:
•	Receipt of fees (if required);
•	Copy of ID card or Passport;
•	Photograph (face only, also as file in repository, provide internet address here below)
____________________________________________________

Place, _________________________

Date, _________________________

Signature_________________________________