mod a/3 autocertificazione di titolo accademico - Università degli ...
mod a/3 autocertificazione di titolo accademico - Università degli ...
mod a/3 autocertificazione di titolo accademico - Università degli ...
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SCRIVERE IN STAMPATELLO MOD A/3<br />
AUTOCERTIFICAZIONE<br />
DI TITOLO ACCADEMICO<br />
Io sottoscritt_ COGNOME .....……............................….............................. NOME:...................................................................................<br />
(N.B. Il nome <strong>di</strong>chiarato figurerà sulla pergamena <strong>di</strong> laurea)<br />
nat_ a ...........................................................……….............................................................................. il ........................................…….<br />
(comune)<br />
(provincia)<br />
co<strong>di</strong>ce fiscale......….....................................................…….......……............ citta<strong>di</strong>nanza.................................................…......................<br />
residente a ...........................................................….…….................. via.............................................................…….......….......... n. .....<br />
(comune)<br />
(provincia)<br />
cap................... tel. ........../................ cellulare ……../…………… e-mail ...............................................................………………………<br />
domiciliat_ a .....................................................……….....................via................................................................…….......…............n. ...<br />
(comune)<br />
(provincia)<br />
cap.................... tel. ............/........................................ e-mail ................................................................................................................<br />
•consapevole che in caso <strong>di</strong> <strong>di</strong>chiarazioni false, incorrerò nelle pene stabilite dal Co<strong>di</strong>ce Penale e dalle leggi speciali in materia;<br />
•consapevole che, fermo restando le responsabilità penali, in caso <strong>di</strong> <strong>di</strong>chiarazioni false, decadrò, con effetto retroattivo, dal <strong>di</strong>ritto <strong>di</strong><br />
iscrizione, che mi sarà inoltre annullata la carriera scolastica e non avrò <strong>di</strong>ritto al rimborso della tassa <strong>di</strong> iscrizione.<br />
<strong>di</strong>chiaro sotto la mia responsabilità<br />
•<strong>di</strong> aver superato presso la Facoltà <strong>di</strong>........................................................................................................................…… dell’Università<br />
<strong>di</strong> .................................................................. l’esame <strong>di</strong> (es. laurea, <strong>di</strong>ploma,ecc.) ...............................................................................in<br />
................................................................................................................................................................... nel giorno …...........….…. con<br />
punti ..............conseguendo il <strong>titolo</strong> <strong>accademico</strong> <strong>di</strong>................……..........……. In .....................................................................................<br />
•per il conseguimento del <strong>titolo</strong> predetto ho superato i seguenti esami <strong>di</strong> profitto, riportando le votazioni a fianco <strong>di</strong> ciascuno in<strong>di</strong>cate ed<br />
espresse in trentesimi:<br />
Insegnamento SSD CFU Data Voto<br />
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I dati inseriti saranno trattati unicamente per finalità istituzionali dell'Università <strong>degli</strong> Stu<strong>di</strong> <strong>di</strong> Parma (Co<strong>di</strong>ce in materia <strong>di</strong> protezione dei dati personali – d.lg. 30/6/2003, N. 196).<br />
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SCRIVERE IN STAMPATELLO MOD A/3<br />
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I dati inseriti saranno trattati unicamente per finalità istituzionali dell'Università <strong>degli</strong> Stu<strong>di</strong> <strong>di</strong> Parma (Co<strong>di</strong>ce in materia <strong>di</strong> protezione dei dati personali – d.lg. 30/6/2003, N. 196).<br />
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SCRIVERE IN STAMPATELLO MOD A/3<br />
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•<strong>di</strong> aver <strong>di</strong>scusso una <strong>di</strong>ssertazione scritta avente il seguente <strong>titolo</strong>:<br />
...................................................................................................................................................................................................................<br />
...................................................................................................................................................................................................................<br />
….......................................................................………………………………………….……................................................................…….<br />
Relatore:………..........................................................................................................................................................................................<br />
Materia <strong>di</strong> <strong>di</strong>ssertazione: ...........................................................................................................................................................................<br />
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•<strong>di</strong> essere a conoscenza del <strong>di</strong>vieto <strong>di</strong> iscrizione contemporanea a corsi <strong>di</strong> laurea triennali, corsi <strong>di</strong> laurea specialistica, dottorati <strong>di</strong><br />
ricerca, corsi <strong>di</strong> <strong>di</strong>ploma <strong>di</strong> specializzazione e master presso la stessa o altra università (art. 2 comma 1 e art. 29 comma 2 del<br />
Regolamento Didattico <strong>di</strong> Ateneo).<br />
Parma, ……………… .......................................................<br />
(firma)<br />
I dati inseriti saranno trattati unicamente per finalità istituzionali dell'Università <strong>degli</strong> Stu<strong>di</strong> <strong>di</strong> Parma (Co<strong>di</strong>ce in materia <strong>di</strong> protezione dei dati personali – d.lg. 30/6/2003, N. 196).<br />
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