Request - English

Request for Admission
2011-2012
Collegio S. Lorenzo da Brindisi, Roma

requests the Admission of the following friar to reside at Collegio San Lorenzo, Rome:

Family Name

Name

Religious Name

Date of birth

Place of birth

Province or State

Nation of birth

Citizenship

Passport Number

Date of Perpetual Profession

Date of Presbyteral Ordination

E-Mail Address

Cellular Phone

1. Studies to be undertaken:

University

Faculty or Department

Specialization


Indicate the Academic Degree sought

Time allowed for the completion of these studies

2. Does the friar suffer from any medical condition (diabetes, hypertension, eg.)? Yes No
If yes, please indicate what those conditions are:

3. Curriculum studiorum:

a. Studies completed:
b. Academic degrees or diplomas already obtained:
c. Registration at the Roman Universities usually require an “above average” academic performance in previous studies. In general, how would you judge the academic performance of the candidate in his previous studies? Poor Average Above average Superior

4. Previous Activities and Assignments:

5. Reasons and goals for undertaking of these studies:

6. Knowledge of Languages:

What is the friar's mother tongue?

What other languages does he know?

What is his competence in the Italian language?

What is his competence in the Latin language?

Does he intend to participate in the Italian language course organized by the Collegio at Frascati? (If so, arrival must be planned for April 27, 2009)	Yes No

Does he plan another way of learning Italian?	Yes No

Universities require the knowledge of at least two “modern” languages (NB: three for the Doctoral candidates). Do you foresee that, during his stay at the Collegio, this friar will have to take other language courses? Yes No

Which languages?

Who will pay the expenses?NB: This is not included in the General Study Grant

7. Payment:

a. Indicate who will pay the daily rate for room and board and the tuition for the university?

If "another" will pay, please indicate which Province.

Do you intend to request a Study Grant?	Yes No

From whom will it be requested?

b. Indicate the treasurer/contact person for payment of personal expenses:

E-Mail Address

Telephone Number / Cell

Other useful information:

Date:

Place:

Major Superior's Address:

Major Superior's Telephone Number:

Major Superior's E-Mail Address:

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