UNIVERSITA' DEGLI STUDI DI PAVIA

TO THE UNIVERSITY CHANCELLOR

REQUEST FOR CURRICULAR REQUIREMENTS EVALUATION

THE UNDERSIGNED
GIVEN NAME __________________________ FAMILY NAME____________________________
PLACE OF BIRTH_______________________ DATE OF BIRTH ____/____/____
PLACE OF RESIDENCE_____________________________________________________________
__________________________________________________________________________________
PHONE________________________________ MOBILE___________________________________
E-MAIL___________________________________________________________________________
c NOT YET GRADUATED

c GRADUATED

c 3-YEAR DEGREE IN_________________________________________________________________

c 5-YEAR DEGREE/MASTER'S PROGRAM IN____________________________________________
requires that her/his curricular requirements be evaluated for admission to the
Master's Program in____________________________________________________________________
DATE ____/_____/_____

SIGNATURE___________________________________________

Attachments:
c a copy (front and back) of a valid photo ID;
c the receipt of the payment for the assessment procedure;
c a degree certification with a list of the taken exams issued by the university where the degree was
awarded, authenticated by the Italian Diplomatic Authorities and translated into Italian or English;
c the program relevant to each of the courses issued by the university where the degree was
awarded, translated into Italian or English.
To be filled in by the applicant
Mrs/Mr________________________________________________________________ presented a request
for curricular requirements pre-evaluation
for admission to the Master's Program in_____________________________________________________
__________________________________________________________
Date ___/____/____
(to be filled in by the university personnel)
The secretary_________________________________