1. Surname: Last Name
2. Surname at Birth: Last Name at Birth (former family name)
3. First name: First Name
4. Date of Birth - Day/Month/Year (example 21/06/1989)
5. Place of Birth (city and state): answer accordingly
6. Country of Birth: answer accordingly
7. Current Nationality (nationality on your passport): answer accordingly
8. Sex (m/f): answer accordingly
9. Marital Status: answer accordingly
10. In the case of minors: N/A
11. National Identity Number: your Social Security number
12. Type of Travel Document: check the box for "ordinary passport"
13. Number of Travel Document: your passport number
14. Date of Issue: answer accordingly
15. Valid until: passport expiration date
16. Issued by: answer accordingly
17. Applicant's home address and email/telephone: answer accordingly
18. Residence in a country other than the country of current nationality: answer accordingly
19. Current Occupation: "Full-time Student"
20. Name and Address of Educational Establishment: answer accordingly - list your Home School
21. Main Purpose of Journey: check the box for "STUDY"
22. Member State of Destination: "ITALY"
23. Member State of First Entry: Please refer to your flight itinerary:
• If you fly directly into Italy, list "ITALY"
• If your flight connects through any European country (except for the UK and Ireland), list that country
• If your flight connects through the UK or Ireland, list - "ITALY"
24. Number of Entries requested: "MULTIPLE"
25. Duration of the Intended Stay (indicate number of days in program, only): answer accordingly
26. Schengen Visa issued during the past three years:
• Answer "yes," only if you have received a Schengen county visa within the last three years. Otherwise, check the "NO" box
27. Fingerprints collected previously for the purpose of applying for a Schengen Visa: answer accordingly
28. Entry Permit for the Final Country of Destination: N/A
29. Intended Date of Arrival in the Schengen Area: List the Start Date for your program
30. Intended Date of Departure from the Schengen Area: List your Program end date - if you are going to travel after the program your status will revert to tourist
31. Inviting Person - Address, email/telephone - answer according to your program and refer to your Italian Institution Letter:
• The Umbra Institute – Daniel Tartaglia
• Accademia Italiana – Barbara McHugh
• Mediterranean Center for Arts and Sciences - Lucia Ortisi
• Universitá del Salento – Dr. Patrizia Guida
• Universitá degli Studi Roma Tre - Paolo Desideri
32. Inviting Company/Organization:
Tina M. Rocchio
The College of Global Studies Italy Programs
c/o Universita' degli Studi Roma Tre, Rettorato
via Ostiense 161, stanza 208
00154 Roma Italia
33. Cost of Traveling and Living during the applicants stay is covered:
• Check box - "by the applicant" and check "cash" & "credit cards"
• Check box - "by a sponser" list: Arcadia University (as in #32) and check "accomodation provided"
34. Personal Data of the Family Member who is an EU Citizen: N/A
35. Family Relationship with an EU Citizen: N/A
36. Place and Date: N/A
37. Signature: N/A
(Bottom of Form) Place and Date: place and date of signature
(Bottom of Page): Signature: sign
• If you are appearing in person at the consulate, sign in front of a Visa officer
• If you have permission to mail your application to the consulate, please have your signature notarized by a notary public