Fondazione International Heart School J.W.Kirklin-Lucio Parenzan Personal Data Family Name Given Name Gender Date of birth Place of birth Country Citizenship Telephone Mobile Email Home Address Residence Address Town Country Postal code Current home adress (if different from residence address) Town Country Application Declaration I declare on my responsability: I hold a Master/Postgraduate/Second level degree I declare on my responsability: I hold a bachelor/ungraduate/First level degree I declare on my responsability: I hold a single cycle degree I declare on my responsability: I hold other kinds of degree I declare on my responsability: I hold english level A/B/C Master/Postgraduate/Second level degree information I hold a Master degree in Duration (in years) Achived in date With the following final mark/grade (if any) In scale of At the following university Notes Please send to info@ihs-bergamo.it a copy of translation in English or Italian of each document stated under Application Delaration. Send
