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Homepage
Chi siamo
Advisory Board
Comitato Direttivo
Consiglio Scientifico
Staff UCBM Academy
Offerta formativa
Master di I e II livello
Corsi di Perfezionamento
Formazione Permanente
Corsi ECM
Executive Program
Formazione per le aziende
Formazione Docenti
Simulation Center
Team Coaching e Intelligenza Emotiva
International
News
Gallery
Contatti
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International Short Program | Pre-registration form
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Step
1
of 10
SECTION 1 – Type of Application
Please select your category:
*
Erasmus+ Staff Mobility
Students / Professionals / Researchers / External Staff
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SECTION 2 – Personal Information
Name
*
Nome
Cognome
Role
*
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University Staff
Student
PhD
Professor
Researcher
Professional
Other
If “Other”, please specify
*
University / Company / Institution of affiliation
*
Email address
*
Phone number (including country code)
*
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Date of birth
*
Age
*
Gender
*
Female
Male
Prefer not to say
Codice Fiscale / National Insurance Number
*
Nationality
*
Country of residence
*
Full address
*
(Street name and number, city, postal code)
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SECTION 4 – Academic / Professional Status
Which of the following best describes you?
*
University Student
PhD
Post-doc
Researcher
Professional
Other
If “Other”, please specify
*
If you are a student, please indicate:
Course of study
*
Year
*
University
*
Institutional affiliation
Are you a UCBM student?
*
Yes
No
Are you from a UCBM Partner University?
*
Yes
No
If yes, please specify
*
Mobility information
Are you currently studying or working outside Italy?
*
Yes
No
If yes, where?
*
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SECTION 5 – Language & Skills
What is your level of English?
*
Upper-intermediate (B2)
Advanced (C1)
Proficient (C2)
Native Speaker
I don’t know
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SECTION 6 – How did you hear about the International Week?
the you read
How did you hear about the International Week?
*
Personal recommendation
Università Campus Bio-Medico di Roma (UCBM)
Partner University
Social media
LinkedIn
Other
If other, please specify
*
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SECTION 7 – Required Documents (Download & Upload)
Download Erasmus Staff Agreement
Click here and Download Erasmus Staff Agreement
Upload completed and signed Erasmus Staff Agreement (PDF only)
*
Drag & Drop Files,
Choose Files to Upload
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SECTION 8 – Privacy & Consents (GDPR)
I declare that I have read and understood the privacy notice regarding the processing of personal data pursuant to Article 13 of the GDPR:*
*
Having read and understood the privacy notice regarding the processing of personal data pursuant to Article 13 of the GDPR:
Read the privacy policy
I consent to the production and publication of photographs, videos and audio-video recordings during the International Week for institutional communication purposes.
I consent to the production of photographs, videos, and audio-video interviews containing my image and/or voice during the International Week promoted and organized by Università Campus Bio-Medico di Roma (“University”), for publication and dissemination by any means of communication and diffusion, without exception (e.g. institutional web channels, television, institutional communication channels, social network channels used by the University) for the purpose of disseminating and promoting the University’s institutional initiatives
I consent to receive promotional and informational communications related to UCBM educational activities
I consent to the sending of promotional and marketing communications by the University, including the sending of newsletters, relating to the educational offer and to the professional training and teaching activities (e.g. postgraduate courses, internships, Masters, etc.), as well as market research, surveys, invitations to events and initiatives promoted by the University, through both automated tools (SMS, e-mail, automated calling systems without an operator, use of social networks, WhatsApp) and traditional means (postal mail, telephone with an operator)
I consent to the processing of my personal data for profiling purposes in order to receive personalized communications
I consent to the processing of my personal data by the University for the purpose of analyzing my personal data, including aspects relating to my university and/or professional career, my personal preferences, and my interests, in order to enable the University to create a profile of me and to send me personalized promotional communications more in line with my needs
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SECTION 9 – Image Rights Waiver
Please read the Waiver and Transfer of Image Usage Rights and select one option
*
I consent
I do not consent
Waiver and Transfer of Image Usage Rights
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SECTION 10 – Final Declaration
I confirm that the information provided is accurate and complete.
*
I confirm that the information provided is accurate and complete.
I understand that this is a pre-registration only and that participation will be confirmed upon payment of the registration fee at a later stage.
*
I understand that this is a pre-registration only and that participation will be confirmed upon payment of the registration fee at a later stage.
Submit Pre-Registration
