M1023 - Rev. 00 del 28.02.07 - Richiesta di immatricolazione studenti extra ue Domanda di immatricolazione B inglese by stariya

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									                                EXTRA UE STUDENTS ADMISSION
                                                         (WRITE IN CAPITAL LETTERS)
      TO BE PRESENTED TO THE ITALIAN EMBASSY/CONSULATE OF STUDENTS HOME
                                   COUNTRY
To the courtesy attention of the
Accademia di Belle Arti di Brescia – SANTAGIULIA Director
Via Tommaseo, 49
25128 Brescia

Name _................................................ Surname………………………………………

Born …………………………………………………..on………………………………………

Nationality ………………………………………gender ( ) M ( )F

Adrress ………………………………………………………………………... ………………………………….…………

……………………………………………………………………………………nr …………………..zip code…………………….

Telephone number (international phone code included)………………………mobile phone…………………………………………
e-mail………………………………. Fax number (international phone code included)…………………………………………….




                                                                 I ASK
To be admitted to the first of two years courses (specialization) of:

          [ ] PAINTING                    [ ] SCENOGRAPHY                 [ ] SCULPTURE
          [ ] GRAPHICS                    [ ] DECORATION                  [ ] RESTORATION

For the 2007/2008 academic year
NECESSARY DOCUMENTS FOR THE ADMISSION:

- To be admitted, it is necessary the possess of a high school diploma or equivalent recognized by italian authorities. The Diploma
must be translated and legalized by Italian Embassy or Consulate of your home origin country (independently from the country the
school is located) The Italian Embassy/Consulate will issue a “VALUE DECLARATION”. This document will certify your diploma
equivalence respect to the Italian ones.
If you have any doubt about the validity of your diploma, please contact the Italian authorities located in your home country.

PLEASE ENCLOSED ALSO:

     -    Copy of passport
     -    Birth certificate
     -    Copy of the wire bank transfer to be headed to Cooperativa V. Foppa – Accademia di Belle Arti SantaGiulia di Brescia
          ABI 3500 – CAB 11208 – CIN T C/C n 14666 (please indicate in the description name, surname, course chosen and
          admission year)

The enrolment fee, will only be refunded only if VISA is rejected and the Secretary office will receive a
rejection declaration issued by Italian Embassy.
In that case the Academy will retain € 200.00 for administrative fees.
ALL THE DOCUMENTS MUST BE SENT TO THE SECRETARY OFFICE BY E-MAIL OR BY FAX (please write to
segreteria@accademiasantagiulia.it or fax to 0039 030 3389557) WITHIN 10 MAY 2007.


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

It is declared that, in compliance with Law 196/2003 containing provisions for safeguarding individuals that any personal information by you given
will be treated in accordance with the principle of just usage and with full respect for your privacy and other rights.


                                WELL READABLE SIGNATURE_____________________________________________________________


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