ࡱ > r u q Y ? bjbj 0$ ii ; W W W W W k k k 8 < k P Y Y Y O O O O O O O $ R JU t O W Y Y Y Y Y O W W H O Y ^ W W O Y O F l J țe j H * mO O 0 P -H U ! j U T J J J U W )K D Y Y Y Y Y Y Y O O B Y Y Y P Y Y Y Y U Y Y Y Y Y Y Y Y Y [ : Al Magnifico Rettore
Di 鶹ýAV߿ University
Il/La sottoscritto/a ________________________________________ nato/a il ______________________ a ___________________ PROV. (____) con Cittadinanza: ______________________________________e residente a ________________________ in Via ________________________________n _____ CAP_________ tel:________________ cell: ______________ e-mail: __________________________
chiede di essere ammesso a partecipare alla selezione per lammissione al Master di II livello in Cardiologia Interventistica attivato da 鶹ýAV߿ University per lA.A. 2023/2024.
A tal fine, consapevole delle sanzioni penali previste in caso di dichiarazione mendace e della decadenza dai benefici eventualmente conseguiti per effetto del provvedimento emanato sulla base della dichiarazione non veritiera (artt. 75 e 76 del D.P.R. 28 Dicembre 2000, n. 445), presa visione del bando di selezione ed accettate tutte le condizioni e prescrizioni in esso previste, dichiara sotto la propria responsabilit di essere in possesso dei seguenti titoli:
Laurea magistrale/specialistica/vecchio ordinamento in ____________________________________________ conseguita nellanno accademico___________ presso lUniversit ________________________ con votazione ___________________
Specializzazione medicina in ____________________________________________ conseguita nellanno accademico___________ presso lUniversit ________________________ con votazione ___________________
Abilitazione allesercizio della professione conseguita nellanno________ presso lUniversit_____________________
Dichiara inoltre:
di essere iscritto allOrdine/Albo _____________________ della Provincia di _____________________
DATA _____________________
FIRMA
_________________________
Allegato A
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