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Personal data

Name*
Surname*

Gender*

Date of birth*
Country of birth*
City of birth*
First Citizenship*
Codice Fiscale - Italian Tax Code Number*
Foreign Student without Codice Fiscale

Identification document

Identification document type *
Identification document number *
Document issued by *
Document expiry date *

Citizenship

The candidate declares to be:

italian citizen

citizen of another European Union country (different from Italy)

Citizens of one of the following countries: Norway, Iceland and Liechtenstein, Switzerland, Republic of San Marino and the Holy See

Non-EU candidates with dual citizenship, one of which is Italian or from another EU country

Non-EU citizens in possession of a long stay visa

non-EU citizens not resident in Italy

Permanent address

Country of residence *
City of residence *
Street, number *
(Ex.: High Street - Jabotinsky Street - etc.).
Street number *
Postal Code *
Is the domicile different from the residence? *

No Yes

Domicile address

C/O
Country of domicile *
City of domicile *
Street, number *
(Ex.: High Street - Jabotinsky Street - etc.).
Street number *
Postal Code *

Access data

WARNING:
- If you use a certified mailbox, it must be able to receive ordinary mail messages;
- It is not advisable to use email accounts HOTMAIL as communications sent by the system could be interpreted as SPAM; Email *
Confirm email *
Username*
Password (minimum 8 characters)*
Confirm password*

Contacts

Phone number *
Mobile
Certified Email

I declare that I have read and understood the information on the processing of personal data provided by Università Campus Bio-Medico di Roma pursuant to Article 13 of Regulation (EU) No 2016/679. I authorise Selexi s.r.l. to process my personal data and consent to their subsequent communication to Università Campus Bio-Medico di Roma for purposes related to participation and management of the admission procedure.

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