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Count O N L Y the number of

days of the program from

Housing C heck In to

Housing C heck O ut.

22. C ity of destination

23. State of fi rst entr y

E V E N I F Y O U A R E

W R I T E I T A L Y, B O L O G N A

W R I T E C I T Y A N D C O U N T R Y W H E R E Y O U R F I RST

A R R I V I N G A F E W D A YS

F L I G H T L A N DS A F T E R D E P A R T I N G T H E U.S.

B E F O R E O R L E A V I N G A

F E W D A YS A F T E R T H E

24. Number of entries requested/ ...............................:

25. Dur ation of the stay. Indicate number

PR O G R A M. For full year

of days (max. 365 days) /

students, count from

O n e / . .. . . .

T w o/ . .. . . .

M ultiple/.............

.......................................................:

Housing C heck In of the

L IST T H E N U M B E R O F D A YS O F T H E T E R M

first term until the last day

C H E C K M U L T IP L E

of F inal E xams of the

26. Schengen visas issued during the past three years / ......................... ........................:

second term.

N o / . . .

L I S T O T H E R V I S A S O B T A I N E D , O T H E R W I S E , C H E C K

N O

Yes. Date(s) of validity / .............. from/....

to /..

27. F inger pr ints ta ken previously for the pur pose of applying for a Schengen visa

T he Schengen area

................................................ .................... . . .............................................:

includes: A ustria,

C H E C K N O U N L E SS T H IS A PP L I E S T O Y O U

Belgium, Denmar k,

N o/...

Y es/.... Date, if known/......................

F inland, F rance,

Must

Germany, G reece,

match

28. Number of no objection document issued for family reunification/accompanying family/employment (only in

Iceland, Italy,

flight

case where required by legislation gover ning the type of being requested)/ ...........................................................

L uxemburg, T he

itinerary

Issued by SU I of /..........................................

D O E S N O T A PP L Y W R I T E N A

Netherlands, Norway,

V alid f rom/.....................

until/....

Portugal, Spain and

29. Intended date of a r r ival in the Schengen a rea

30. Intended date of depar ture from the Schengen area

Sweden.

......................................................................

(only for visas valid for stays of between 91-364 days)

DD/MM/YYYY

..........................................................

DD/MM/YYYY

A C T U A L D A T E Y O U W I L L A R R I V E

A C T U A L D A T E Y O U W I L L D E PA R T

31. Sur name and first name of the inviting person or employer. If not applicable, in case of visa for A doption,

Religious reasons, M edical reasons, Spor ts, Study, M ission: address of institution in Italy.

...................................................................... .................................... .......... ......................................... .

L IST I NSI T U T I O N I N I T A L Y

B rown in Italy, V ia Belmeloro 7, 40126 Bologna, Italy

Phone: 39-051-2960906

A ddress and e-mail address of inviting person(s) or

T elephone and fax of inviting person(s) or

employer...............................................

employer

................................................................................

32. Name and address of inviting company/organisation

T elephone and fax of company/organisation

/.......................................................

.................................................................

Sur name and first name, address, telephone, fax and e-mail address of contact person in company/organisation/

.......................................................................................................................................................

33. Cost of travelling and living expenses is covered by /.......................................................................:

by the applicant himself/herself/

by sponsor (host, company, organisation),

specify/ ........................................................

..........................................

C H E C K H I MSE L F/ H E RSE L F

Refe r r ed to in field 31 or 32 / .......................

Means of support/..........................................:

othe r (please

C H E C K A L L T H A T APPL Y

specify)/..........................

C ash/ ..............................