Unione Europea	
REGIONE AUTONOMA DELLA SARDEGNA
CENTRO REGIONALE DI PROGRAMMAZIONE	
Repubblica Italiana	

P.O.R. sardegna 2000 - 2006
Misura 3.13
“RICERCA E SVILUPPO TECNOLOGICO NELLE IMPRESE E TERRITORIO”

SUMMER DistrICT CAMP

APPLICATION FORM

APPLICANT’S INFORMATION
Please fill out all sections in capital letters

PERSONAL DETAILS

Last name: ……………………………………………………

First name: …………………………………………………..

Date of birth …………………………….  Place of birth………………………………………………..

Gender …………………………………. Nationality …………………………………………………….

Home address  ……………………………………………………………………………………………..

Country ………………………………………………………………………………………………………

Telephone number………………………………………. Email address…………………………….

EDUCATION

Institution …………………………………………………………………………………………….

Town …………………………………………………………………………………………………….

Country ………………………………………………………………………………………………...

Attended from ………………………………………   to …………………………………………..

Qualification or degree ……………………………………………………………………………

LANGUAGE SKILLS

Mother tongue: ………………………………………………………………………………………..

English: …………………………………………………………………………………………………

Spanish: ………………………………………………………………………………………………..

French: …………………………………………………………………………………………………

German: ………………………………………………………………………………………………..

Other: …………………………………………………………………………………………………..

Computer knowledge and experience:
………………………………………………………………………………………………………………...
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………

Briefly describe a possible project or idea, to be developed into one of the nine Technological Laboratories of the District. 

	

Note ex art. 13 Law 196/2003	

According to article 13 of the Italian Law n. 196/2003 for the protection of persons with respect to the treatment of personal data, the treatment of data you are entrusting to us, is based on principles of probity, transparence and safeguard of your discretion and rights. 

Therefore, we inform you about the following: 

1. Your data will be treated for the following purposes: selection for attending the Summer DistrICT Camp, within the activities of the DistrICT, in order to develop and carry out innovative and development projects.  

2. Treatment will be made with the following methods ( manual and computerized). 

3. Conferring data is obligatory and the possible refuse to provide them and to allow their treatment, will imply the impossibility to apply for the selection.  Il

4. Data will neither be communicated to other nor spread 

5. Owner of the treatment is Sardegna Ricerche head office via Palabanda, 9 09123 Cagliari.

6. Responsible for the treatment of data is Ing.. Andrea Redegoso. E-mail: privacy@sardegnaricerche.it

7. In any moment you could exercise your rights, according to the art. 7 of the Italian Law.196/2003.

The undersigned gives his consent for the treatment of personal data, for the purposes above indicated. 

Place .......................       .... Date ..............................................

Signature ..........................................................................................