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. ID# - You may use your Social Security number
6. Place and Country of Birth (city & state, country): answer accordingly
7. Current nationality/ies: answer accordingly
8. Original Nationality (nationality at birth): answer accordingly
9. Sex (m/f): answer accordingly
10. Marital Status: answer accordingly
11. Father's name: answer accordingly
12. Mother's name: answer accordingly
13. Type of Passport - National Passport
14. Number of Passport: your passport number
15. Issued by: answer accordingly
16. Date of Issue: answer accordingly
17. Valid until: answer accordingly
18. If you reside in a country other than your country of origin, have you permission to return? In most cases this would not apply or "N/A".
19. Current Occupation - "Full-time Student"
20. Employer and employer's address and telephone number – Your University/College Information
21. Main Destination – Write your program city in Italy.
22. Type of Visa – Long stay (for summer session, circle "Short Stay")
23. Visa - Individual
24. Number of Entries requested – Multiple
25. Duration of Stay – total number of program days
26. Other Visas – answer accordingly
27. In the case of transit – N/A - This does not apply, call if you have questions.
28. Previous stays in this or other Schengen States – If you have traveled or stayed in any of the Schengen Countries, you may list them and the dates here.
29. Purpose of Travel – Full-time Study in a University Program
30. Date of Arrival – Program date
31. Date of Departure – Program end date – List your Program end date - if you are going to travel after the program your status will revert to tourist
32. Border of First Entry in the Schengen states – 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"
33. Means of transport – Plane unless you come by ship or train.
34. Name of Host or Company Name – write the name of the Director of Italy program school.
• The Umbra Institute – Daniel Tartaglia
• Accademia Italiana – Barbara McHugh
• Mediterranean Center for Arts and Sciences - Lucia Ortisi
• Universitá del Salento – Dr. Patrizia Guida
Telephone – Italy School Program Phone number – see the Program website
• Umbra – www.umbra-institute.com
• Accademia – www.accademiaitaliana.com
• MCAS - www.mediterraneancentre.it
• Lecce – www.unile.it
Full Address – Italy School Program address – see the Program website
• Umbra – www.umbra-institute.com
• Accademia – www.accademiaitaliana.com
• MCAS - www.mediterraneancentre.it
• Lecce – www.unile.it
35. Who is paying for your travel and costs during your stay - list "myself"
36. Means of support during your stay – Cash/credit cards, etc. – Mark all that apply
37-42. Spouse/children info: answer accordingly or N/A
43. Personal data of EU or EEA citizen you depend on: "N/A – not applicable"
44. No response required
45. Applicant's Home Address: answer accordingly
46. Telephone number: answer accordingly
47. Place and Date: place and date of signature
48. 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