To the kind attention of the Rector of the
UNIVERSITÀ DEGLI STUDI DI PERUGIA

I, THE UNDERSIGNED, (PLEASE INDICATE FULL NAME)
 ________________________________________________________________________________________________
DATE OF BIRTH ___________________ PLACE OF BIRTH __________________________________________________
ADDRESS OF RESIDENCE: (CITY /AREA) ________________________________________ ZIP/POSTAL CODE_________
STREET __________________________________________________________________________________________ 
TEL. __________________
FISCAL CODE ______________________________________
ADDRESS FOR COMMUNICATION: (CITY/AREA)________________________________ ZIP/POSTAL CODE __________
STREET __________________________________________________________________________________________
TEL. __________________
E-MAIL (please enter a valid email address) __________________________________________________________________ MOBILE PHONE NUMBER____________________________
HEREBY ASK:
 to be enrolled, for the 2018/2019 A.Y., in the FIRST year of the DOCTORAL DEGREE COURSE IN:______________________________________________________________________________________________
CURRICULUM IN __________________________________________________________________________________
Herewith committing to attend the course according to the procedures approved by the Board of Teachers I declare
 That I am to benefit from the scholarship as per the Call for Applications of the DR _______ of _________
 That I am not to benefit from the scholarship;
I also declare, under my own responsibility and in accordance with articles 46 and 47 of the D.P.R. 28/12/2000 no. 445:
 That I am a citizen of _____________________________;
 That I hold a Degree in _____________________________________ (please specify the “Classe di laurea” –Classification of Degree), awarded on ____________ (date) at the University of _____________________________________________ with a final graduation mark of _______________________;
 That I hold a High school degree in _____________________________________, awarded on ____________ (date) at the School of _____________________________________________ with a final graduation mark of _______________________;
 That I have not already been the recipient/beneficiary (even only partially) of another scholarship aimed at attending a Doctoral Course at an Italian University (only for scholarship holders);
 That I am aware of the fact that, according to art. 6,  1st comma of Law no.398/1989, the accepted scholarship cannot be benefited from together with other scholarships, regardless of the reason, with the only exception being those scholarships awarded by national or foreign institutions and aimed at integrating, through periods of stay abroad, the educational activity of scholarship holders (only for scholarship holders);
 That I am not enrolled, for the same year, in any other Doctoral Course, Degree Course, Specialization School, (with the exception of the last year of a Specialization Medical Course at the Università degli Studi di Perugia, in accordance with art. 7 of the D.M. 45/2013), or in a Master at the Università degli Studi di Perugia or at another University. (When enrolled in another Degree course, Specialization School or Master Degree, the enrolment in said Degree Course, Specialization School or Master must be suspended for the entire legal duration of the Doctoral Course). 
 To  be enrolled in the ______ year of the Specialization Medical School in ________________________________________________________________ at the Università degli Studi di Perugia; 
 That I am the recipient of a research grant (assegno di ricerca) with a duration of _____________, effective from _______________________             
 That I am not the recipient of a research grant (assegno di ricerca);
That I  am  am not, (please tick the pertinent box) a public servant, as per art.2 of the Law 13/08/84 no.476:
That I  am  am not, (please tick the pertinent box) a private company employee or other type of worker (please specify) _________________________________________________________________________________________;
 To commit to provide a copy of the permit of stay as soon as it is available (only for non-EU citizens); 
 To undertake to inform immediately, in writing, this University, should one of the aforementioned affirmations vary or cease to be true.

The undersigned also declares to be aware that:
1.	Enrolment in Doctoral Courses is incompatible with any kind of work activity, unless said activity is to be carried out for a limited amount of hours and under the condition that the Board of Teachers has previously granted its approval.
2.	Of the penal sanctions in which the undersigned would incur in case of false declarations or those that contain data that no longer correspond to the truth, as foreseen by article 76 of the D.P.R. 28/12/2000, no. 445.
3.	Of article 75 of the D.P.R. 28.12.2000, no.445 regarding the relinquishment/loss of any benefits resulting from the action that is to be issued in the case that, following verification, the Administration were to find proof of false content in the above-mentioned declaration.

Should this Administration request it, at any stage of the proceedings, the undersigned commits to certify, by presenting proper documentation and in accordance with the law, the declarations attached to the present application under his/her own responsibility.

The undersigned, according to the D.Lgs. 196/2003 (Code of Regulations on the Protection and Processing of Personal Data) declares that he/she is aware that his/her data will be used by the University for institutional purposes and in compliance with the principle of pertinence.

_____________________						SIGNATURE
                (Place and date)		      			_______________________________