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P ' ' ' ^ w w O ' O ' ' F l 9K w ^ ]H * O P 0 PP H V { V T 9K 9K J V K \ ' O O * PP V : Al Magnifico Rettore
Di 鶹ýAV߿ University
Il/La sottoscritto/a ________________________________________ nato/a il ______________________ a ___________________ PROV. (____) con Cittadinanza: ______________________________________e residente a ________________________ in Via ________________________________n _____ CAP_________ tel:________________ cell: ______________ e-mail: __________________________
chiede di essere ammesso a partecipare alla selezione per lammissione al Master di I livello in Formazione di Team Leaders di Sala Parto e Gestione delle Complicanze Ostetriche attivato da 鶹ýAV߿ University per lA.A. 2025/2026.
A tal fine, consapevole delle sanzioni penali previste in caso di dichiarazione mendace e della decadenza dai benefici eventualmente conseguiti per effetto del provvedimento emanato sulla base della dichiarazione non veritiera (artt. 75 e 76 del D.P.R. 28 Dicembre 2000, n. 445), presa visione del bando di selezione ed accettate tutte le condizioni e prescrizioni in esso previste, dichiara sotto la propria responsabilit di essere in possesso dei seguenti titoli:
Laurea triennale/magistrale/specialistica/vecchio ordinamento in ______________________ conseguita nellanno accademico___________ presso lUniversit _____________________________ con votazione ___________________
Abilitazione allesercizio della professione conseguita nellanno________ presso lUniversit_____________________
Dichiara inoltre:
di essere iscritto allOrdine/Albo _____________________ della Provincia di _____________________
Dichiara altres (specificare il possesso di eventuali altri requisiti richiesti dal bando):
___________________________________________________________________________
___________________________________________________________________________
DATA _____________________
FIRMA
_________________________
Allegato A
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