FORM A

APPLICATION FORM for the assignment of travel expenses contribution incurred by students for training or thesis research outside the country

surname………………………………………  name  ………………………………………………
enrolment n°(matricola) …………………………………………………….
telephone number …………………………………………………………
e-mail address   …………………………………………………………
degree course  …………………………………………………………
year (first, second or third) ……………………………………………
n° of credits achieved (within the date of application)…………………… ……..
Period of activity ouside the country  ………………………………………………………
Hosting institution/COUNTRY ……………………………………………………………………… 
activity (training, thesis research)……………………………………………………………..

TUTOR PROFESSOR OR SUPERVISOR ……………………………………………………………..

									STUDENT’S SIGNATURE
								………………………………………
Date:	…………………………………………	

Enclosures:

•	List of exams (or self certification)
•	Tutor professor’s/supervisor’s declaration (indicating kind and period of the activity to be carried out)

Application forms duly signed and enclosures have to be delivered at the Department of Land, Environment, Agriculture and Forestry - 2nd floor - 1st stecca - not later than 2nd April 2015, 12.00 a.m. (ref. Sara Ziggiotti, Monica Barzon)

For further information: sara.ziggiotti@unipd.it