INTERNATIONAL MOBILITY – SCHOOL OF ENGINEERING
APPLICATION FORM year 2022-2023

				Al Presidente della Scuola di Ingegneria
 Servizio Relazioni Internazionali
Scuola Ingegneria
 Via Santa Marta, 3 – 50139 Firenze

The undersigned  _________________________________________  matricola nr.  ______________ 
Place of birth ________________________________________ date of birth __________________________
email:  ______________________@stud.unifi.it   cell phone ___________________________________

pursuant to and for the purposes of the d.p.r. 445 of 28/12/2000, aware of the penal sanctions resulting from false declarations, formation and / or use of false documents as well as the forfeiture of any benefits resulting from the provision issued on the basis of false declarations
	
DECLARES

•  to be enrolled at  ___________________	 year of the __________________
    Bachelor degree in  ____________________________________________
	Master degree in __________________________________

•	To possess the requisite as described in art. 3 of the call to participate in the International Extra-UE mobility of the School of Engineering;
•	To have knowledge of the following languages: 
(choose an option)

•	An official certification of th language  ______________________level:

      B1    B2     C1    C2/mother tongue   

Issued by (Istitute / School / CLA / Other)………………………………………………………………………………

Street ………………...……………………City …………………………………………….ZIP code………………..   

ASK

to be admitted to the selection of candidates fro the International Extra-UE mobility of the School of Engineering for the following Institution, total months and semester: 

    Host Institution 			Country        months               	 semester

   ___________________________    _________       ______		__________

Toi this end, I attach the following documentation:
1.	Copy of Extra-UE agreement
2.	Internship/ Final project work program
3.	Learning Agreement (if applicable)
4.	Equivalence forms received from the reference teachers relating to the exams selected at the host institution (if applicable)
5.	Self-certification of the list of exams with grades, that the candidate has taken both in Bachelor and Master Degree study courses 
6.	A motivational letter to the mobility
7.	Copy of a valid Identity Card/Passport
8.	Other documents useful by the applicant for the purposes of the selection (for example, certificate of knowledge of the English language)

Date: ………………………………….		Signature  ....………………………………..

Information pursuant to the personal data protection code
(Art. 13 of the legislative decree 30 June 2003, n. 196 and subsequent amendments)
The University of Florence will process personal data also with the aid of IT tools, exclusively for the purposes of the procedure in question and to a relevant extent, not excessive and strictly necessary for the pursuit of its institutional functions.
Communication and dissemination of personal data
Pursuant to Article 11 of the Implementing Regulation of the personal data protection code held by the University of Florence and without prejudice to the right to object for reasons of legitimacy pursuant to art. 7 of Legislative Decree 30/06/2003, n.196, authorizes the communication and dissemination of my personal data in the possession of the University to public or private entities that request it in order to facilitate orientation, training and the professional and work placement, even abroad, of young students.
YES    NO 

Date: ………………………………….		Signature        ………………………………