Divisione 1st and 2nd level degree corse
REQUEST FORM FOR THE EVALUATION OF SPECIFIC ADMISSION REQUISITES
FOR 2ND LEVEL DEGREE COURSES
2015/2016 ACADEMIC YEAR
The present request is valid for the assessment of previous curriculum for the purpose of
subsequent pre-enrolment/enrolment in a second level degree course.
The undersigned__________________________________________________________________
(Last name)
(First name)
Italian tax code (Codice Fiscale)._____________________________________________________,
(codice fiscale)
born on __________________ in_____________________________________________________
(birth date)
(birth place)
and resident in ____________________________________________________________________
(city of residence)
_________________________________________________________ no.___________________
(street name)
(street number)
Cell phone no.__________________________ email address______________________________
Requests
the assessment of his/her previous study program for the purpose of admission to the second level
degree course in:
_____________________________________________________________ (class_____________)
(name of the 2nd level degree course)
(example: LM-10)
and based on the provisions of Articles 3 and 46 of the Presidential Decree n. 445/2000 and aware
that, in accordance with art. 76, whoever who issues false statements, makes or uses false
documents, shall be punished under the Penal Code and the laws concerning these matters and
furthermore incurs in the loss of the benefits of art. 75, declares to this end1:
o (for graduate students) to have obtained a degree in_________________________________
_______________________________________________________ (class_____________)
On ______________ in the University of________________________________________
(date)
With a grade of____________________________.
o (for undergraduate students2) to be enrolled for the ________________ academic year in the
University of ______________________________________________ in the degree course
in______________________________________________________(class_____________)
and to have already achieved at least 120 university credits required for graduation.
1
In accordance with article 13 of the law. n. 196/03, students should be informed that the data provided will be
processed by University of Siena, located in Via Banchi di Sotto 55, 53100 Siena
The data is collected and processed exclusively to carry out the institutional aims of the University; the refusal to
provide your personal data could result in failure to carry out the necessary requirements and administrative procedures
for the management of students' careers.
In any case all interested parties are entitled to the rights under Article 7 Legislative Decree n. 196/03.
2
See the appropriate section of the annual study manifesto for first and second level degree courses and single cycle
degree courses for the 2015/16 academic year.
The undersigned further declares that in the academic years ________________ he/she was
enrolled in the degree course in__________________________________________________ in the
University/Institute of______________________________________________________________
and to have carried out the following exams with the grades given in thirtieths.
Name of exam – SSD3 - CFU4
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The undersigned declares to be aware that
above email address.
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the response to present instance will be received at the
Grade
Date
Date;______________________
Student’s Signature:____________________________
• For the evaluation this form must be filled out properly in its entirety and presented with a
copy of a valid identity document.
RESERVED FOR CONTACT PROFESSOR OR PRESIDENT OF DIDACTICS COMMITTEE
We hereby declare that, following the verifications made on the basis of the Academic Regulations
for the Second level degree course and for the University, the status of the above mentioned student
is the following:
o Possession of the required curricular requisites and personal preparation (the student may
proceed to enrolment in the Ufficio studenti e didattica)
o Verification of the requisites – access to verification of personal preparation (the student
may proceed to pre-enrolment in the Ufficio studenti e didattica)
o Verification of the requisites – no requisites for enrolment (the student may not proceed to
enrolment)
Siena,____________________
3
4
President’s/Professor’s signature____________________
Settore Scientifico Disciplinare = Scientific sector code
Crediti Formativi Universitari = University credits