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Modulo per accettazione candidatura

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  • 1. ELEZIONI RAPPRESENTANTI DEGLI STUDENTI NEL CONSIGLIO DI CORSO DI STUDIO IN_____________________________________________________________ BIENNIO 2012 - 2013 29 e 30 MARZO 2012 Modulo per accettazione della candidaturaIO SOTTOSCRITT _________________________________________________________NAT A ___________________________________________IL __________CODICE FISCALE _________________________________________________________RESIDENTE A _________________________________________________P.ZZA/VIA _______________________________________________________________TEL. ___________________CELL. _______________________________ISCRITT PER L’A.A.2011/2012 AL________________ (indicare anno di iscrizione) DELCORSO ________________________________________________________________MATR. _________________________ E-MAIL ________________________________ DICHIARO DI ACCETTARE LA CANDIDATURA NELLA LISTA DENOMINATA:__________________________________________________________PER IL SEGUENTE ORGANO: ____________________________________________DICHIARO ALTRESÌ DI NON AVER PRESENTATO LA MIA CANDIDATURA IN LISTE DIDIVERSA DENOMINAZIONERoma li _________________________ Firma del candidato ___________________________Io sottoscritto ______________________ dichiaro autentica la firma apposta in miapresenza da ________________________________, identificato con documento in corso divalidità ___________________________ _____ rilasciato da _______________________in data ___________________________________________________________Firma e timbro dell’ufficiale autenticanteLuogo e data

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