MODULO IN AUTOCERTIFICAZIONE SELF-DECLARATION FORM

(Substitute Declaration as stated by art. 46 DPR 445/2000)

La/il sottoscritta/o I undersigned						 CF (for Italian citizens only) 						 nata/o a born in ____________________________( 	) il/on 	/ 	/ 	, residente a/living in 				( 	)
Indirizzo/address 	
consapevole che chiunque rilascia dichiarazioni mendaci è punito ai sensi del codice penale e delle leggi speciali in materia, ai sensi e per gli effetti dell'art. 46 D.P.R. n. 445/2000

aware of the liabilities applied in case of false declarations as stated by art. 76 of DPR 445/2000

DICHIARA / DECLARE

•	di non partecipare al programma Erasmus o a Tirocini nel periodo marzo – luglio 2026
•	I will not join the Erasmus Program or Traineeships from March to July 2026
•	di non laurearsi prima di Luglio 2026
•	I will not obtain the Master Degree before July 2026

Voglio partecipare a TACC perchè / I want to join the TACC program because (max 500 caratteri / max 500 characters – *mandatory field to fill in English)
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Descrivi brevemente il problema/bisogno che ritieni rilevante affrontare in TACC / Briefly describe the problem/need you think is relevant to address in TACC ((max 500 caratteri / max 500 characters – non-mandatory field to fill in English)

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Descrivi brevemente la soluzione che vorresti sviluppare in TACC / Briefly describe the solution you would develop during TACC (max 500 caratteri / max 500 characters – non-mandatory field to fill in English)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Data /
Date, 			

_____________________________________Firma del dichiarante (per esteso e leggibile)
Signature	

Dichiara di essere informata/o, ai sensi e per gli effetti di cui al D.Lgs. 196 del 30 giugno 2003, che i dati personali raccolti saranno trattati, anche con strumenti informatici, esclusivamente nell’ambito del procedimento per il quale la presente dichiarazione viene resa.

I hereby declare to be informed as stated by D. Lgs 196 of 30 June 2003, that the collected personal data will be processed, even with electronic systems, only in the frame of the procedure for which this declaration is given.