TO THE DIRECTOR OF THE DEPARTMENT OF GENERAL PSYCHOLOGY –
UNIVERSITY OF PADUA

The undersigned

Surname	Name	Tax code	

		
Date of birth	Place of birth	Country of birth	

		
Address 	City of residence	Town or foreign Country of residence	

		
Post Code	Telephone number	Email address	

Requests

to be admitted to participate in the CALL FOR THE DOCTORAL AWARD - DPG Award for Outstanding Doctoral Research, an initiative and contribution of the Department of General Psychology of the University of Padua, aimed at PhD graduates of the 37th and 38th cycle of the Doctoral Courses of the University of Padua, who had a supervisor affiliated with the DPG, whose scientific path has been particularly relevant, solid, and impactful in the field of Psychology research
For this purpose,

pursuant to Articles 46 and 47 of Presidential Decree no. 445 of 28 December 2000, aware of the administrative and criminal sanctions referred to in Articles 75 (Loss of benefits) and 76 (Criminal provisions) in cases of false statements and declarations,

declares

□	to hold a PhD degree obtained on …………………………… at ………………………………… programme ……………………………, cycle ……. .
□	to have completed the three-year period of the PhD Programme in ……………. [programme name], 38th cycle, and to have been admitted to the evaluation of the final dissertation;
□	not to have any marital relationship or kinship or affinity, up to the fourth degree inclusive, with a professor or permanent researcher belonging to the Centre or to the host research structure, nor with the Rector, the General Director, or a member of the University Board of Directors;

Pursuant to Articles 46 and 47 of Presidential Decree 445/2000

also declares

□	that the information stated in this application is true and correct;

Attachments:
□	Support letter from the PhD supervisor who approved the thesis
□	Extended Abstract
□	Self-presentation and self-application letter
□	Publication most representative of the PhD work
□	Copy of an identity document.

The processing of personal data provided by applicants is carried out in compliance with the provisions of EU Regulation 27.04.2016 no. 679 (General Data Protection Regulation - GDPR).

Personal Data Processing
□	The undersigned declares to have read the information notice regarding the processing of personal data 
□	The undersigned authorizes the Data Controller and the Data Processor to process personal data under the terms specified in the above-mentioned information notice. 
Declaration of responsibility
□	The undersigned, pursuant to Articles 46 and 47 of Presidential Decree 445 of 28/12/2000, aware of the sanctions provided for by Articles 75 and 76 of the same decree and subsequent amendments and additions, certifies the truthfulness of the statements made in this application.

Date,
									Signature