Registration Form Personal Information Name Surname E-mail

Registration Form
Personal Information
Name
_________________________________
Surname
_________________________________
E-mail
_________________________________
Nationality
_________________________________
Age/Gender
__________
Address
_________________________________
City
_________________________________
Province
_________________________________
Country
_________________________________
Telephone/ Mobile
_________________________________
How did you learn about the school?
M ___ F ____
□ Search engines
□ Web advertising
□ Social media
□ Recommended by a friend
□ Promotional brochure or pamphlet
Course Information
Course selected
Start
□ Standard Italian course
□ Individual Italian course
□ Intensive Italian course
□ Language specialisation course
____________________________*
Duration
□ 1 week
Italian language level
□ 2 weeks
□ 3 weeks
□ 4 weeks
□ more than 4 weeks
□ None
□ Elementary
□ Intermediate
□ Good
I will apply for a student visa with the Italian Consulate?** □ Yes □ No
Fondazione Campus Studi del Mediterraneo
Via del Seminario Prima, 790 - 55100 - Monte San Quirico Lucca Tel. +39 0583 333420 Fax +39 0583 333256 P.IVA 01848560460
[email protected] - www.fondazionecampus.it
Accommodation
Type
□ No preference
□ Shared apartment
□ Independent apartment
□ San Frediano Hostel
□ Hotel
□ B&B
Other requests
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
* Insert an approximate date
** For non-EU students it is necessary to apply for a visa at the Italian Consulate. For more information contact
the School Administration Office.
Privacy Policy in accordance with article 13 of the Legislative Decree no. 196/2003
The data provided on this page will be handled by the Fondazione Campus – Mediterranean Studies, using manual and computerised
instruments, in accordance with the current regulations regarding the protection of personal data, only for the purpose of your request.
Providing the data is optional: in the case that the data is not provided, your request will not be processed. The data is accessible to and will
be handled only by subjects delegated to the fulfilment of the activities and the verifications connected to the objectives described above . The
Data Handler is the Fondazione Campus – Mediterranean Studies, Via del Seminario I nr. 790, 55100 - Monte San Quirico, Lucca: To
exercise the right to access your personal data (art. 7 of the Legislative Decree 196/03) write to the Privacy Controller: Antonio Abatangelo,
Fondazione Campus – Mediterranean Studies, Via del Seminario I nr. 790, 55100 - Monte San Quirico, Lucca.
Date, _______________________
Signature______________________________________
Fondazione Campus Studi del Mediterraneo
Via del Seminario Prima, 790 - 55100 - Monte San Quirico Lucca Tel. +39 0583 333420 Fax +39 0583 333256 P.IVA 01848560460
[email protected] - www.fondazionecampus.it