FORM A

APPLICATION FORM for the SELECTION OF N° 4 “EXCHANGE STUDENTS” FOR A SEMESTER AT THE UNIVERSITY OF SYDNEY (AUSTRALIA) 
JULY-NOVEMBER 2016

surname………………………………………  name  ………………………………………………
enrolment n°…………………………………………………….
telephone number …………………………………………………………
e-mail address   …………………………………………………………
degree course  …………………………………………………………
year of Course (first, second or third) ……………………………………………
n° of credits achieved (by the application date) …………………………………………………..
activity (studyin, training, thesis research)……………………………………………………………..

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

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

Enclosures:

-	list of exams by the date of application (through self-certification in UNIWEB; students enrolled in Laurea Magistrale courses  will also include self-certification of the Laurea Triennale degree with exams list and votes)
-	English proficiency certificate or other useful document 
-	a declaration of the tutor or supervisor, stating the kind of activity to be carried out abroad and the period
-	declaration from a Professor of the Hosting University confirming the supervision (for instance Acceptance Letter, e-mails, etc.).

Application forms duly signed and enclosures have to be delivered at the Department of Land, Environment, Agriculture and Forestry - 2nd floor - 1st stecca  within:

-	18th April 2016, 13.00 am 

For further information: sara.ziggiotti@unipd.it