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STUDENT’S APPLICATION FORM

SENDING INSTITUTION

Country:

University:

Faculty / Department:

 

Address:

 

Postal code:

 

Town:

 
 

Departmental Coordinator

First name and last name

 

E-Mail:

  
 

Institutional Coordinator

First name and last name

 

E-mail:

  

STUDENT'S PERSONAL DATA

Family name:  
First name:  
Gender:
Date of birth:
(dd/mm/yyyy)
  
City of birth:  
Country of birth:  
Nationality:  
Permanent Address:  
Current Address (if different):
Telephone (mobile):  
E-mail:   

DISABILITY

Please specify below if you have any disability and say how it might effect your studies:

LANGUAGE COMPETENCE

Native language:  
Language at your home institution (if different):
Level of language competence in Italian:  
Level of language competence in English:  
Language competence in:  level: 
Language competence in:  level: 

CURRENT STUDY

Field of study enrolment at home institution:  
Level:  

STUDY PERIOD AT IVARESE02

Duration of stay:  
University location:  
Duration of stay (months):    
Planned date of arrival (dd/mm/yyyy):    
Planned date of departure (dd/mm/yyyy):    

ACCOMODATION

Please indicate if you wish to be accommodated in student's house
YOU CAN SELECT ONLY ONE ANSWER, ACCORDING TO YOUR STUDY COURSE!!!!
Collegio Cattaneo - VARESE
(students in Economics, Informatics, Medicine and Surgery, Biology, Communication Sciences)
Collegio La Presentazione - COMO
(students in Law, Tourism, Languages, Physycs, Mathematics, Chemistry)

ITALIAN LANGUAGE COURSE

Please indicate if you wish to attend a free Italian Language Course, basic level
 

(* obligatory fields)