Application Form:

CALL FOR APPLICATION FOR THE SUMMER SCHOOL
“SPATIAL HEALTH ECONOMETRICS” 
Deadline: 25 May 2022 at 12.00	

The undersigned (surname, name)		

 Fiscal code																	

Date of birth		
Place of birth		

Residence address (City)		Postcode		

Street name		House number		

Phone		e-mail		

Current position		
University/Institution		
Qualification		

DECLARES
⁃	to have read and to accept all the rules of the call of selection issued by the Ca’ Foscari University - Department of Economics.
⁃	to be informed, according to the Italian Legislative Decree n. 196/2003 and GDPR 2016/679, that the above personal data will be processed  also with the support of information technology tools. 

REQUESTS
to be admitted to the selection procedure to participate to “Spatial Health Econometrics” Summer School. 

Annex: 
- Dated and signed Curriculum vitae (maximum 2 pages);
- Motivation letter (maximum 1 page);
- Scanned copy of a valid ID document.

Date  _____________________  Signature ____________________________________________________