DECLARATION IN LIEU OF CERTIFICATION
(ITALIAN PRESIDENTIAL DECREE 28 DECEMBER 2000, NO. 445, ARTICLES 46 AND FF. AND LAW NOVEMBER 2011, NO. 183,
ARTICLE 15)
Laurea magistralis degree course in Science and Technology for Population Health and Wealth
A.A. 2015-2016
Tax Code: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
The undersigned ________________________________________________________________________
born in ______________________________________________ (province: ________.)
on ____/____/_______,
resident of (street name) ___________________________________________________________
no. ______
Municipality _____________________________________________ (province: _________.), Post code.
____________
Nationality _____________________________________
Telephone no.: ________________________ Mobile no.: ________________________
E-mail: _____________________________________________________
DECLARES ON HIS/HER OWN RESPONSIBILITY:
1. EDUCATIONAL QUALIFICATION Art. 2 para. a) (check and fill the relevant option)
□ to have passed the degree examination in
_______________________________________________________
degree class __________________ at the University of _______________________________________
(code, name and M.D.)
on ____/____/______, with a mark of _______________________/_______;
□ to be about to take the degree examination in__________________________________________
degree class __________________ at the University of _______________________________________
(code, name and M.D.)
on ____/____/______,
□ to have obtained the three-year university degree in __________________________________
degree class __________________ at the University of _______________________________________
(code, name and M.D.)
on ____/____/______, with a mark of _______________________/_______;
□ to have obtained or be about to obtain on __/__/____ the following FOREIGN university degree
qualification______________________________________________________________
with a mark of ______________ at the University of
_______________________________________________
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Country: _______________________________________
ATTENTION: EU and non-EU citizens in possession of an education qualification obtained abroad will be
admitted subject to confirmation. Their enrolment will be subject to the validity of the documentation in their
possession regarding the educational qualification obtained abroad, whether it be a university qualification or
a high school qualification as provided for by the regulation in force and by the Italian Ministry of Education,
Universities and Research's protocol no. 7802 of 24/03/2014. The qualifications declared with details of
exams sat shall be accompanied by an enrolment application appropriately including original 'Dichiarazioni di
Valore' (Declarations of Value) drawn up by the competent Italian Diplomatic Authorities. Enrolment will be
also subject to checks by the Examining Board on the suitability of the candidate's preparation in the subject
matters deemed essential for admission into the course of study (see the SSD - scientific and disciplinary
sectors listed in point 2.
THE UNDERSIGNED ALSO DECLARES:
- that the normal length of abovementioned course of study is _____ years;
- to have enrolled on ____/____/______ in the first year of the abovementioned course of study in the
academic year
______/_____
► TO HAVE OBTAINED A HIGH SCHOOL DIPLOMA
____________________________________________________________ (□ five-year □ four-year)
in the academic year_____________________________ with the mark ______________ □ honours
at the school: ________________________________________________________________
□ state school □ legally recognised school
Address: ______________________________________________________________________
Municipality __________________________________________ (province: ______) Post Code.
___________
If the declarant has attained a high school qualification abroad, the declarant must send with this
application the original copy of the qualification, with an official translation in Italian issued by the
competent Italian Diplomatic Authority in the country where the qualification was obtained.
2. ADMISSION TITLES Art. 2 para. a)
THE UNDERSIGNED DECLARES OF HIS/HER OWN RESPONSIBILITY
to have attained at least 50 University credits in the scientific and disciplinary sectors listed below following
the pass result of the exams indicated: BIO/06-COMPARATIVE ANATOMY AND CYTOLOGY; BIO/09PHYSIOLOGY;
BIO/10-BIOCHEMISTRY;
BIO/11-MOLECULAR
BIOLOGY;
BIO/12-CLINICAL
BIOCHEMISTRY AND CLINICAL MOLECULAR BIOLOGY; BIO/13-APPLIED BIOLOGY; BIO/14PHARMACOLOGY; BIO/16-HUMAN ANATOMY; BIO/17-HISTOLOGY; BIO/18-GENETICS; CHIM/03GENERAL AND INORGANIC CHEMISTRY; CHIM/06-ORGANIC CHEMISTRY; CHIM/10-FOOD
CHEMISTRY; FIS/07-APPLIED PHYSICS (TO CULTURAL AND ENVIRONMENTAL ASSETS, BIOLOGY
AND MEDICINE); MAT/05-MATHEMATICAL ANALYSIS; MAT/07-MATHEMATICAL PHYSICS; MED/01MEDICAL STATISTICS; MED/03-MEDICAL GENETICS; MED/04-GENERAL PATHOLOGY; MED/05CLINICAL PATHOLOGY; MED/07-MICROBIOLOGY AND CLINICAL MICROBIOLOGY; M-EDF/01
DIDACTIC METHODS FOR MOTOR ACTIVITY; M-EDF/02 TEACHING METHODS FOR SPORT; MED/45
GENERAL CLINICAL AND PAEDIATRIC NURSING SCIENCE; MED/46 MEDICAL AND LABORATORY
TECHNIQUES; MED/47 OBSTETRICS AND GYNAECOLOGY NURSING SCIENCE; MED/48 NURSING
SCIENCE AND
NEUROPSYCHIATRIC AND REHABILITATION TECHNIQUES; MED/49-APPLIED
DIETETICS; MED/50-APPLIED MEDICAL SCIENCE AND TECHNIQUES.
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Scientific and
Disciplinary Sector
(SSD)
Exam title
Exam date
Credits
Mark
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
EU and non-EU citizens with a qualification obtained abroad will have to include suitable
documentation so that the Examination Board is able to evaluate the suitability of the candidate's
preparation regarding the subject matters deemed essential for admission into the course of study (see
the SSD - scientific and disciplinary sectors indicated in point 2.
3. LANGUAGE CERTIFICATION Art. 2 para. d)
THE UNDERSIGNED DECLARES OF HIS/HER OWN RESPONSIBILITY
o
to be the holder of an English language proficiency certificate of level ___________
obtained at __________________________________________ on ____/____/______
Address ______________________________ no. _________ Municipality __________ (province
________)
o
to have obtained the following qualification in English
________________________________________________________________________________
obtained at __________________________________________ on ____/____/______
Address ______________________________ no. _________ Municipality __________ (province
________)
o
to have acquired, in his/her university curriculum, an English language proficiency level equal to or greater
than B2
(specify)_______________________________________________________________________________
______________________________________________________________________________________
_________________________________________________________________
o
to come from an English-speaking country (specify which one and the years of
residence)______________________________________________________________________________
______________________________________________________________________________________
_________________________________________________________________
The undersigned is aware that issuing false declarations is punishable under
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the Criminal Code and applicable specific laws pursuant to articles 75 and 76 of the Italian Presidential
Decree
445/2000. The undersigned is aware of the provisions in art. 13 del Italian Legisaltive Decree 196/03
(“Data Protection Law”).
Brescia, ______/______/_______
________________________________
(signed by the declarant )
A front and back photocopy of the identity document currently being validated is attached
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