FORM A

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

surname………………………………………  name  ………………………………………………
enrolment n°…………………………………………………….
telephone number …………………………………………………………
e-mail address   …………………………………………………………
degree course  …………………………………………………………
year of Course (first, second or third) ……………………………………………
n° of exams taken  within 1st MARCH 2014…………………………………………………………
n° of credits achieved within 1st MARCH 2014…………………………………………………..
Period of activity ouside the country  ………………………………………………………
Hosting institution/COUNTRY ……………………………………………………………………… 
activity (studyin, 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 31st July 2014, 13.00 hours (ref. Sara Ziggiotti, Monica Barzon)

For further information: sara.ziggiotti@unipd.it