SELF-CERTIFICATION FORM 
EDUCATIONAL QUALIFICATIONS
Art. 46 D.P.R. (Presidential Decree) no. 445, 28th December 2000 	

 The Undersigned (family name, first name)		

 Place of Birth (city)		Date of Birth		

Country 		Nationality/ Citizenship		

aware of the penalties imposed by the Penal Code regulating false statements, redacting or using false documents 
DECLARES
to have been awarded the following academic qualification(s) and that the said qualification(s) satisfy the requirements for access to first cycle tertiary education in the awarding country, or continuing to second cycle or further level study:
□ School qualifications required for admission to university level studies 

Secondary studies Type		

Qualification Title		

Duration of studies (no. of completed years from first 
grade at primary school)		Date completed		Final mark		

Mark scale (max mark; min mark)		

Name of Institution		Education level		

City/town		Country 		

□ University qualifications required for admission to post-graduate studies

Qualification Type		

Qualification Title		

Duration of studies (no. of completed years from first 
grade at primary school)		Date completed		Final mark		

Mark scale (max mark ; min mark)		

University/College		level		

City/town		Country		

□ that the country the title was awarded does/does not* have selective entry requirements to the  course applied for in   the single/all*   university seats; 
□ that enrollment   is/is not*   subject to exams of academic suitability.
* delete as appropriate
further DECLARES
to have taken and passed the following exams in order to access a Master’s Degree course and/or for academic recognition of subjects studied:

Subjects	Date	ECTS or hours of theory/practicals 	Marks	

				

				

				

				

				

				

				

				

Mark scale for each subject		

The undersigned also declares that they have been informed that their personal data will be both handled and processed by use of IT services solely for the institutional purposes required for this certification, in accordance to the provisions of article 13 of Legislative Decree no. 196, 30th June 2003.

date			Signature		

This declaration substitutes, to all intents and purposes, the standard certificate requested by or destined for public administrations as well as public utilities and private individuals. The signature does not require authentication, nor does the declaration require signing in the presence of an employee of the Institution requesting the certificate. A photocopy of the declarant’s valid identity document will be enclosed in lieu of authentication. 
Pursuant article 41 of Presidential Decree no. 445/2000, this declaration is valid for a period of 6 months. Should the documents substituted by this declaration be valid for a longer period of time, this declaration will hold for the same length of validity. Said declaration may be processed by fax or other electronic means as per art. 38 of Presidential Decree no.  445/2000. In accordance to art. 74 paragraph 1 of Presidential Decree no. 445/2000, non-acceptance of this declaration constitutes infringement of official duties.  Exempt from stamp duty as per art. 37 of Presidential Decree no. 445/2000.