Annex 1
Al Magnifico Rettore
dell’Università degli Studi
Suor Orsola Benincasa – Napoli
Via Suor Orsola 10
80135 Napoli
I, the undersigned ___________________________________________________________________________
Tax Code ____________________________________ born in (place)__________________________________
On (date)________________________________resident in________________________________province of
_____at (address)_______________________________________________________post code____________
tel.__________________________________email_________________________________________________
Address for application purposes
City ___________________________________________________ prov._______________________________
at (address)_______________________________________________________postcode__________________
REQUEST
to participate in the selection for admission to the Ph.D in Sugli ambiti di interazione e integrazione tra le
scienze umane e le tecnologie avanzate. Humanities and technologies: an integrated research path XXXI Ciclo
Profilo _________________________________________________________________________________
I DECLARE UNDER MY OWN RESPONSIBILITY
type of scholarship selected____________________________________________ (Should candidates
apply for a designated topic research grant, they must present a research project illustrating the chosen topic
max 3 pages)
that I am a ____________________________________________________ citizen
that I hold a Degree / Master's Degree in __________________________________________________
_________________________________________________________obtained on ____________________
at the University of _____________________________________________with a mark of______________
or the four or five-year degree (in the old Italian system) in _______________________________________
_____________________________________obtained on________________________________________
at the University of_________________________________________________with the mark___________
(only for candidates about to graduate)
I am a graduand student and am aware that admission to the selection process is conditional upon my
obtaining a degree by the date specified in the Notice of Competition.
Degree in________________________________________ at the University of _______________________
presumed date of graduation___________________
(only for candidates with an academic qualification obtained abroad and already having obtained a
Chancellor’s Decree of equivalence)
I hold a Degree in ________________________________________ obtained on _________________
at the University of _________________________________ Country________________________with
a mark of_________
(only for candidates with an academic qualification obtained abroad but not yet having obtained a declaration
of equivalence to Italian qualifications) Candidates with foreign qualifications which have not been declared
equivalent to one of the qualifications required must apply for equivalence to the Academic Board only for the
purposes of the selection process as per Annex 2.
I have a working knowledge of Italian (for non-Italians)
I possess a working knowledge of the English language
I have / have not previously been awarded other scholarships (even for one year) for a doctoral
programme;
I have / have not the PhD
in ___________________________________________obtained on _____ at the University of
____________________________________________________________________________________
I hold /do not hold a research grant;
I am /am not an employee of the Public Administration;
I will attend the PhD programme full-time in the manner to be specified by the Academic Board;
I undertake to inform the University of any change of residence or address for the purposes of the
selection;
I have read the notice of competition.
Applicants with disabilities must specify, in accordance with current legislation, any aid required in relation to
their disability, and any need for additional time for the completion of the examination.
I also declares that I am aware that anyone making false statements is liable to prosecution under the Penal
Code and special laws, pursuant to and by effect of art. 75 and 76 of Presidential Decree 445/2000.
Lastly, I declare that I am aware that the University administration does not accept any responsibility for the
non-delivery of the application due to error attributable to the candidate, or any postal delays attributable to
third parties, unforeseeable circumstances, or force majeure.
ATTACHED TO THE APPLICATION
Annex 1. Photocopy on plain paper of valid ID card or passport.
Annex 2. Curriculum Vitae.
Annex 3. A copy of my degree dissertation in electronic format (preferibly in PDF) on CD-ROM
Annex 4. List of any publications.
Annex 5. Any certificates of proficiency in English (TOEFL, Proficiency or other).
Annex 6. Research project for the designated topic grants
Annex 6. Any other document or qualification demonstrating the candidate's research skills.
Date, _______________________________
SIGNATURE
_________________________________