PACKET B1 ITALIAN VISA FORM TH

Transcript

1 PACKET B1 ITALIAN VISA FORM TH DEADLINE: JUNE 15 Cngratulatins n yur acceptance t Accademia dell Arte! We are excited t meet yu sn. Please nte: All Accademia dell Arte students must have an Italian visa. The Accademia dell Arte will apply fr yur visa. If yu r yur schl wuld prefer t apply fr the visa directly, please cntact us immediately s we can send the required letters t yu r t yur schl fficials. All f fllwing dcuments and materials need t be received in rder t prcess yur visa: VISA APPLICATION FORM. PAGE 1-4 PROOF OF PERSONAL OR FAMILY RESOURCES.. PAGE 5 Yu are applying fr: Lng-term visa ( days), with the ptin f multiple entries. The signature must be ntarized. Signed by bth parents r legal guardian. The signature must be ntarized. INSURANCE COVERAGE Include a letter frm the US insurance cmpany is best r yu can include a cpy f an insurance card with the student s name. If yu d nt have insurance yu must fill ut the DICHIARAZIONE DI IMPEGNO. PAGE 6 COPIES OF: A RECENT BANK STATEMENT YOUR ROUNDTRIP AIRLINE RESERVATION ONE RECENT OFFICIAL PASSPORT PHOTO PASSPORT It is abslutely necessary t submit yur actual passprt - cpies will nt be accepted. Make sure yur passprt is valid fr 6 mnths after visa expiratin date r six mnths after yur date f return t the US. Remember t sign yur passprt! A PREPAID EXPRESS MAIL ENVELOPE TO RECEIVE THE PASSPORT BY MAIL Addressed t where ever yu will be befre yur departure date. If yu plan t depart prir t the ADA prgram arrival date, please let us knw s that we can ensure yur passprt and visa are returned in time fr yur departure. PLEASE SEND ALL MATERIALS IN ONE PACKET THROUGH USPS EXPRESS MAIL TO: Accademia dell Arte PO Bx Little Rck, AR PLEASE DO NOT STAPLE DOCUMENTS! FOR MORE INFO CONTACT: Linda Brwn at r by at lbrwn@dell-arte.rg.

2 Cnslat Generale d Italia FOTOGRAFIA Cgnme /Surname (x) 2. Cgnme alla nascita (cgnme/i precedente/i) /Surname at birth (frmer family name(s)) (x) 3. Nme/i / First names (given name(s)) (x)... Spazi riservat all'amministrazine Data della dmanda: 4. Data di nascita (girn-mese-ann) Date f birth (day/mnth/year 8. Sess /Sex: Maschile/.Male... Femminile/.Female Lug di nascita/place f birth Stat di nascita /Cuntry f birth Stat civile/.marital status...: 7.Cittadinanza attuale/current natinality... Cittadinanza alla nascita, se diversa Natinality at birth,if different... Nn cniugat/a/.single Cniugat/a/Married Separat/a /Separated Divrziat/a /Divrced Vedv/a /widw(er) Altr (precisare) /Other (please, specify):.. 10.Per i minri: cgnme, nme, indirizz (se divers da quell del richiedente) e cittadinanza del titlare della ptestà genitriale/tutre legale/in case f minrs: Surname, first name, address (if different frm the applicant s) and natinality f parental authrity/legal guardian...: 11. Numer d'identità nazinale, ve applicabile /../ natinal identity number, where applicable Tip di dcument/type f passprt: Passaprt rdinari /Ordinary passprt Passaprt diplmatic/ Diplmatic passprt Passaprt di servizi / Service passprt Passaprt ufficiale / Official passprt Passaprt speciale / Special passprt Dcument di viaggi di altr tip (precisare) /Other travel dcument (please, specify) 13. Numer del dcument di viaggi /Number f travel dcument Data di rilasci./date f issue Indirizz del dmicili e indirizz di psta elettrnica del richiedente Applicant s hme address and address Valid fin al /Valid until. 16. Rilasciat da/ Issued by... Numer/i di telefn /Telephne number(s) Residenza in un paese divers dal paese di cittadinanza attuale / Residence in a cuntry ther than the cuntry f current natinality N Sì. Titl di sggirn equivalente/ Yes, Residence permit r equivalent 19. Occupazine attuale /... Current ccupatin... n.... Valid until 20. Datre di lavr, indirizz e numer di telefn. Per gli studenti nme e indirizz dell'istitut di insegnament/emplyer and emplyer s address and telephne number. Fr students, name and address f schl Numer della dmanda di vist: Dmanda presentata press: Ambasciata/Cnslat Centr cmune Frnitre di servizi Intermediari cmmerciale Altr Nme: Respnsabile della pratica: Nme di chi ha ricevut la pratica all sprtell: Dcumenti giustificativi: Dcument di viaggi Mezzi di sussistenza Invit Mezzi di trasprt Assicurazine sanitaria di viaggi Altr Decisine relativa al vist: Rifiutat Rifiutat per segnalazine SIS nn cancellabile. Pratica Sspesa Rilasciat Tip di vist: D 21. Scp del viaggi /Main purpse(s) f the jurney... Ricngiungiment Familiare/Familiare al Seguit / Family reunin visa Mtivi Religisi/ Religius reasns Sprt/.Sprt Missine./Missin... Diplmatic/Diplmatic Cure Mediche./ Medical reasns Studi/Study Adzine/Adptin Lavr subrdinat/subrdinate wrk Lavr autnm /self-emplyment Di altr tip / Other (please, specify). Valid: dal.. al. Numer di ingressi: 1 2 Multipli (x) Alle caselle da 1 a 3 le infrmazini vann inserite cme indicate nel dcument di viaggi. Questins 1 thrugh 3 must be cmpleted accrding t the infrmatin listed in the travel dcument. 1 1

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6 AFFIDAVIT T: Cnslat Generale d Italia 1300 Pst Oak Bulevard, Suite 660 Hustn, Texas Date Name f Applicant (last, first) Self-Supprting I, the undersigned, Name and Last Name brn in n Place Date residing at Street address, City and State have prvided the fllwing dcumentatin prving my financial stability during my stay abrad: Signature Parent/Guardian I, the undersigned, Name and Last Name brn in n Place Date residing at Street address, City and State Depse and say: that I will take financial respnsibility fr my Sn /daughter /wife / husband/parents: Name and Last Name regarding all the expenses which he/she may incur during his/her stay in Italy. Signature U.S. Ntary Public Signature and Seal: 5

7 Dichiarazine Di Impegn Assicurazine Sanitaria Il sttscritt (Last name and first name) nat/a a il (place f birth) (date f birth: dd/mm/yy) avanti a (befre) DICHIARA di impegnarsi ad acquistare al su arriv in Italia: 1. una plizza assicurativa per studenti cn scieta` di assicurazini italiane che prevedan il pagament dirett alle Unita` Sanitarie Lcali delle spese per cure urgenti spedaliere, accmpagnata da dichiarazine che tale plizza nn cntiene limitazini d eccezini per le tariffe previste per il ricver psedalier urgente per tutta la durata del ricver stess. 2. Prende inltre att che la ricevuta di pagament della plizza assicurativa dvra` essere presentata alla Questura Pst di Plizia della citta` di destinazine, cmpetente a rilasciare il permess di sggirn per studi. STATE I, the undersigned, hereby swear that upn arrival in Italy I will purchase: 1. A health insurance plicy issued by an Italian Health Insurance carrier that will pay directly the Italian hspitals belnging t the natinal health care system. I will btain a written statement t the effect that the plicy I have purchased has n limitatins r exceptins t the rates established by the Italian public hspitals fr emergency medical care r hspitalizatin, n matter fr hw lng (please, nte that the statement shuld be wrded in Italian as it appears written abve in the Italian prtin between qutes); 2. I have been als infrmed that prper receipt f payment fr such health plicy has t be exhibited t the QUESTURA r POSTO DI POLIZIA, as supprting dcument t my applicatin fr PERMESSO DI SOGGIORNO (permit t stay) fr studying and that is nt later than eight days frm my arrival in Italy. Lett, cnfermat e sttscritt. (Read, cnfirmed and signed) Il Dichiarante Firma (Signature) Befre mailing this statement remember t have yur signature ntarized by a Ntary Public: Signature & stamp f the Ntary Public OFFICE USE ONLY Attest che il/la dichiarante identificat/a da passaprt n. valid fin a, previa ammnizine sulla respnsabilita` penale cui pu` andare incntr in cas di dichiarazine mendace, ha sttscritt in presenza mia/del ntai pubblic la suestesa dichiarazine. Hustn,.. NOTE Majr Italian Health Insurance cmpanies ffer plicies with health cverage fr students; fr instance, the ISTITUTO NAZIONALE DELLE ASSICURAZIONI INA-ASSITALIA ffers a student health insurance plicy with the required cverage. The cst fr INA s plicy is subject t change and payment shuld be made thrugh a pstal mney rder (CONTO CORRENTE POSTALE) t the accunt n under the name f AGENZIA GENERALE DI ROMA INA ASSITALIA, Via del Tritne n. 131, Rma. Le maggiri cmpagnie di assicurazine italiane ffrn plizze assicurative per studenti che prevedn la cpertura medic spedaliera richiesta. A titl indicativ l Istitut Naiznale delle Assicurazini INA-Assitalia prevede unaadeguata plizza per studenti. L imprt di tale plizza e` stabilit annualmente dall INA e deve essere versat sul Cnt Crrente Pstale n intestat a: Agenzia Generale di Rma, INA-Assitalia, via del Tritne n. 131, Rma. 6