Scholarship application form

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I Campi contrassegnati con * sono richiesti.

Personal data will be processed exclusively by our secretariat according to the Italian privacy law (L. 675/96).

First Name *

Last Name *

Born in *

on *

Country *

Address *

City *

Zip / Post Code *

Country *

Passport Number *

Fixed telephone number *

Mobile phone number *

Email *

Profession *

Allergies or pathologies:

EMERGENCY CONTACT:

First Name

Last Name

Fixed telephone number *

Mobile phone number *

Email *

Parental type (e.g. father, mother, brother, sister etc.) *

DESTINATION AND TYPE OF ACCOMMODATION SERVICES:

Village of Belvedere Marittimo; Accommodation with shared room (in apartment)

Village of Santa Severina; Accommodation with Shared Room (in boarding school)

Single room (only in apartment): + 8 Euro per night.

I declare that I have read and accept the general terms and conditions.

I authorize the processing of my personal data in accordance with art. 13 of Italian law n.196/2003 (To send the registration request you must authorize the processing of data)

Scholarship application form

EMERGENCY CONTACT:

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