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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