Sprachenzentrum

Centro Linguistico
Language Center

Universittsplatz 1 - piazza Universit, 1
Postfach 276 C. p. 276
I 39100 Bozen - Bolzano
T: +39 0471 012 400
F: +39 0471 012 409
language.centre@unibz.it

Request for Course Certificate

Name

born in province/country on

present address area code

request:
that a paper-based copy be issued of

the attendance certificate of the language course

he/she attended in (term/year)

the certificate of the exam

he/she took in (term/year).

I declare to use this certificate exclusively for the following reason (indicate one option only)

personal

for the police

to be used outside Italy

and I enclose two 16,00 stamps

Bozen - Bolzano, Signature

(The identity of the applicant has been proven)

I allow the Language Centre to use my personal data in accordance with Legal Decree no. 196/2003 (personal data protection code).

Stamp and signature of admin staff responsible for procedure

Date

Da consegnare presso la Segreteria del Centro Linguistico

language.centre@unibz.it