INTERNSHIP REPLACEMENT ACTIVITY

The undersigned (family name)__________________(name) _________________
Student no. _______________________ Bachelor Degree / Master’s Degree in ____________________________________________________________________

Place of Birth ________________________ (Province____) Date of Birth _________
Resident in the Muncipality of _______________________________(Province ____)
Address in via/piazza  __________________________________________________
tel. _______________________ , e-mail ___________________________________
Tax code ____________________________________________________________

Initiative/Event
Title _____________________________________________________________
Place held ________________________________________________________
Date of activity:  from ______________________ to _______________________
Starting from the hour ______________________ to _______________________

The Internship Replacement Activity involves:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

University Tutor ____________________________ Signature _________________

Venice, _______________ Student Signature ____________________________

EVALUATION OF ACTIVITY IN TERMS OF CREDITS
(to be completed by the University Tutor): 
Scientific Preparation:                     Activity held in:     	     Final Report: 
Total:
University Tutor Signature: date __________ signature ___________________