Document to be returned duly signed by email attachment at: info@selinusuniversity.

it

LONDON, UK
Ph.D. APPLICATION FORM 71-75 Shelton Street, Great
London WC2H 9JQ
N US E
Italian branch:

Uniselinus Europe
LI Via Pompeo Scipione Dolfi, 4
U
UNISE

ROPE

40122 Bologna, Italy

Tel. 051 19909972
Mediterranean Operative Area:
n e t wo r k i n g u n i v e r s i t y 97100 Ragusa, Via Roma, 200
Tel. 0932 518985
www.uniselinus.education

doctor of philosophy (ph.d.) by research via distance learning

Name Surname
Country and Nationality Date of birth City of birth
Resident in Current Address
Zip Code Phone number E-mail address
Being interested in following a Uniselinus Europe study program to get a Doctor of Philosophy degree in

I Ask to be admitted to the pursuit of academic research in the following subject:

(research area)

My research work will culminate in a final thesis titled:

Write here the title of the final thesis

My final thesis will be submitted within: 6 months 12 months 18 months 24 months (Mark the expected time)
Academic Qualifications:

Relevant Work Experiences:

Attach a copy of the following documents: Identity card or passport, 1 passport size photo, CV.
Philosophy Doctor (Ph.D.) Total amount Eur 2.275,00 Payment plan
Select Instalment Plan: The payment method will be by bank transfer
Single payment 4 consecutive monthly
instalments or paypal within 10 days since receipt of
10% discount € 2.050 the Enrollment Certificate.
of € 568,00
2 consecutive monthly 6 consecutive monthly The bank details will be communicated at
instalments instalments the time of the enrollment
of € 1.137,00 of € 379,00
I declare that in the case of acceptance of the proposal by Uniselinus I am committed to diligently follow my research program and to present the final thesis in the established time. I declare to have read
the web campus www.uniselinus.education and have found the Uniselinus status, its private accreditation, its organizations, its studio system, suitable for my purposes. I declare that I am aware that my
degree may be issued only if all the fee are paid. Finally, I declare that all the information recorded in my CV is real and truthful and that it is Uniselinus's authority to delete me from the program in case of
false statements.

Date, place and signature

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