ANNEX  1 – APPLICATION FORM
University Corridors for Refugees - UNICORE 4.0 (Cameroon, Niger, Nigeria - 2022-2024)
To be sent via email to unicore@adm.unipi.it  in compliance with art. 4

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(Please complete this application form in capital letters)
PERSONAL INFORMATION
Surname          ………………………………………………………………………..
Name                ………………………………………………………………………..

Date of birth     ………………………….:………………………………………….
(dd/mm/yyyy)  	   				
Place of birth    ..…………………………………………..............................
( Town/Country)
Refugee ID card number ……………………………………………………….
and/ or Ration Card Number of Proof of  Recognition ……………………………………………………
     
Citizenship    	………………………………………………………………………
Gender         	 ………………………………………………………………………    
City /Country of residence  …...………………………………………………..    
Address        	….…………………………………………………………………..		       
Mobile phone 	……………………………………………………………………….
E-mail                  .………………………………………………………………………
Skype/other platform account ….……………………………………………..

SELECTED PROGRAMMES (MAX TWO options, in order of preference among those listed in Annex 2)
1.	_________________________________

2.	_________________________________

HAVE YOU APPLIED FOR OTHER UNIVERSITIES WITHIN PROJECT?
(If you have, please list the University and the selected degree programme)

1.	_________________________________

2.	_________________________________

3.	_________________________________

PERSONAL STATEMENT
Please briefly summarize (about 5 lines) your professional profile, your future professional goals and your motivation.
…............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

WORK EXPERIENCE
From …. To …..:
Job role   …......................
Company or Institution name …......................
Brief description of your role and responsibility 
…......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
From …. To ….:
Job role   …......................
Company or Institution name …......................
Brief description of your role and responsibility 
…......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

EDUCATION
Bachelor’s Degree
Complete name of the final qualification ………………….…...........................................
Graduation Date     ….................................................................................................
Awarding University …...............................................................................................
Faculty/Department …...............................................................................................
Thesis title (if any) …..................................................................................................
Final score (if any) …..................................................................................................

Cumulative Grade Point Average (GPA)  ….................................................................................................
(GPA documentation should be included in the application including each semester GPA and cumulative GPA according to the tertiary education grading system of the country of graduation or equivalent according to the comparable table issued by the Italian Ministry of Education)
High school Diploma
Complete name of the final qualification ….................................................................................................
Name of high school ….................................................................................................
Graduation Date      …..................................................................................................
Final Score (if any)  ..….................................................................................................

Other educational experiences
School name (with town and country) ……..................................................................
Course/programme title ….................................................................................................
From …. to ….

LANGUAGES
Level of language proficiency: M: mother tongue, A: elementary, B: intermediate, C: advanced
LANGUAGE	WRITING LEVEL	SPEAKING LEVEL	

			

Language certifications:
Please list here any language certification achieved. If available, please attach to the application a scanned copy of the certification
…...................................................................
…...................................................................

COMPUTER SKILLS
Brief description of your computer skills
………....................................................................................................................................................................
………....................................................................................................................................................................

PERSONAL SKILLS
Brief description of your personal skills

………....................................................................................................................................................................
………....................................................................................................................................................................

HOBBIES
………....................................................................................................................................................................

I authorize the processing of personal data contained in this application form according to art. 13 of Legislative Decree 196/2003 and art. 13 GDPR (EU Regulation 2016/679) for the sole purpose of personnel research and selection.

I give consent to publish my Refugee ID card number or Ration card number of my Proof of Recognition in the final ranking list of admitted  candidates on the website http://universitycorridors.unhcr.it/ and http://www.unipi.it/unicore4.0

I hereby declare to fully accept all the terms and condition specified  in the UNICORE 4.0 Call for applications for 2 study grants and welcome services for refugee students registering for Second Cycle degree programmes taught in English at the University of Pisa, for the Academic Years 2022-24.
I also declare to promptly inform the University of Pisa of any change it may occur in my personal data.

Place and Date 							Signature
__________________________                                                      ______________________________        

Check list of the required documents to annex to the application form: 
	A Copy of your currently valid Refugee Identity Card and/or the Proof of Registration issued in collaboration with UNHCR;
	An official certificate confirming the qualification required for admission to the selected degree programme and issued by the awarding university; 
	Official transcript of exams passed and relative marks; 
	Any other relevant and additional document required by the specific selected degree programme (included but not limited to a certification of English language profieciency, see Annex 2). 
	A motivation letter (maximum two pages).

•	A short video CV (e.g. using mobile phone) introducing yourself and your motivations.
(Examples for a video CV creation can be found in Google.com. Candidates can send the video via https://wetransfer.com/ to the email address unicore@adm.unipi.it) 
 Applicants will be emailed on the video receipt.  It is not required to annex the video to the requested documentation.
IMPORTANT: All documents submitted by applicants should be in English or Italian language.
All documents in any language other than Italian or English must be supported by a translation into English or Italian on plain (no letterhead) paper. During the application stage, it is not required a certified translation, but it is mandatory to provide the original documents.