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APPLICATION FORM 2014

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University of Pisa DESTeC
CAV Visual Arts Center of Pietrasanta
Municipality of Pietrasanta
THE CITY AND THE WATER
ARCHITECTURE, ARTS AND DESIGN FOR THE NEW WATERFRONT OF MARINA DI PIETRASANTA
September 3th - 14th 2014
APPLICATION FORM 2014
Please read the following instructions carefully before completing this form.
1.
The workshop fees amount to:
500,00 Euros - full fee: covering accommodation, breakfasts, lunches and the teaching material.
250,00 Euros - reduced fee: provided for participants who do not require the accommodation and
breakfasts.
Fees covers accommodation, breakfasts, lunches and the teaching material. Fees do not include living
expenses.
2.
The application form must be compiled in all its parts and sent by e-mail to:
[email protected] with a CV and an ID document copy by July 31th 2014.
3.
Candidates will be notified of acceptance by August 4th 2014.
4.
Payment will be possible after acceptance notification. Selected students have to pay the fees in full
by August 10th 2014. Participants are asked to pay by bank transfer to the account:
Fondazione Centro Arti Visive di Pietrasanta
IBAN: IT59 H087 2670 2200 0000 0036 020
Bank Name: BCC Banca di Credito Cooperativo della Versilia Lunigiana e Garfagnana
Causal of payment: Workshop - Admission Fees - Name and Surname of the participant.A confirmation of
the
wire
transfer
(copy
of
the
receipt)
must
be
submitted
by
e-mail
to
[email protected] by August 10th 2014. If payment is not received within the
timeline specified, University of Pisa will treat this as a rejection of its offer and the student will not be
booked on the workshop.
5.
In case this workshop will not be activated, the amount will be refund.
Section 1: PERSONAL DETAILS
Last Name: ____________________________________________________________________
First Name: ____________________________________________________________________
Male/Female: □ M □ F
Date of Birth: ___/____/___ (day/month/year)
Nationality: __________________________
Address: _______________________________________________________________________
E-mail address: _________________________________________________________________
Phone Number (With international code): _____________________________________________
Actual Occupation (If a full-time student, please state your academic institution here):
_______________________________________________________________________________
University of Pisa DESTeC
CAV Visual Arts Center of Pietrasanta
Municipality of Pietrasanta
THE CITY AND THE WATER
ARCHITECTURE, ARTS AND DESIGN FOR THE NEW WATERFRONT OF MARINA DI PIETRASANTA
September 3th - 14th 2014
Section 2: ACADEMIC and EDUCATIONAL BACKGROUND
University: ____________________________
Please specify your academic status:

Bachelor Student

Bachelor Graduate

Master Degree Student

Long Cycle Master Degree Student

Master Graduate
Brief Curriculum Vitae: (200 words, please attach a full CV to the Application Form):
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
_______________________________________________________________________________________
Language Skills
Native: ___________________________________
English: □ Listening □ Reading □ Speaking
Italian: □ Listening □ Reading □ Speaking
Attached to the application form
1. the personal Curriculum Vitae in English
2. the list of the approved exams, specifying the final vote and ECTS or CFU amount for each exam
(only for students)
3. copy of the personal ID document or passport
Date
____/______/_____
If you require further assistance in completing the form please contact
Stefania Landi
Email: [email protected]
Tel:
+39 050 2217917
Post: DESTeC Area Architettura e Urbanistica
c/o Università di Pisa, Scuola di Ingegneria, DESTeC
Largo Lucio Lazzarino 1, 56122 Pisa (Italy)
Signature (hand-signed)
_________________________________
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