During the Mobility Last name(s) First name(s) Sex [M/F] Study cycle Field of education Student Contact person: name, phone number, e-mail Name Faculty/Department Address Country address University of Verona International Relations Office International Office Sending Università degli ITALY +39 045 802 8596 / 8196 Via dell’Artigliere 8, Institution Studi di Verona relazioni.internazionali@ateneo.univr.it 37129 Verona Contact person: name, phone number, e-mail Receiving Name Faculty/ Department Address Country address Institution Exceptional changes to Table A (to be approved by e-mail or signature by the student, the responsible person in the Sending Institution and the responsible person in the Receiving Institution) Number of Table A2 Component Component title at the Receiving Deleted Added ECTS credits code Institution component component Confirmed component During the (or equivalent (if any) (as indicated in the course catalogue) [tick if applicable] [tick if applicable] mobility credits) Total: Exceptional changes to Table B (to be approved by e-mail or signature by the student, the responsible person in the Sending Institution and the responsible person in the Receiving Institution) Table B2 Component Deleted Added Number of Component title at the Sending Institution code component component Confirmed component ECTS credits During the (as indicated in the course catalogue) (if any) [tick if applicable] [tick if applicable] (or CFU) mobility Total: Signatories Name Email Position Date Signature Student Student Delegato all’internazionalizzazione di Dipartimento at the Sending Institution Academic Coordinator Responsible person at the Receiving Institution
During the Mobility Student Last name(s) First name(s) Sex [M/F] Study cycle Field of education Sending Institution Name Faculty/Department Address Country Contact person: name, phone number, e-mail address Università degli Studi di Verona University of Verona International Office Via dell’Artigliere 8, 37129 Verona ITALY International Relations Office +39 045 802 8596 / 8196 relazioni.internazionali@ateneo.univr.it Receiving Institution Name Faculty/ Department Address Country Contact person: name, phone number, e-mail address Exceptional changes to Table A (to be approved by e-mail or signature by the student, the responsible person in the Sending Institution and the responsible person in the Receiving Institution) Table A2 During the mobility Component code (if any) Component title at the Receiving Institution (as indicated in the course catalogue) Deleted component [tick if applicable] Added component [tick if applicable] Confirmed component Number of ECTS credits (or equivalent credits) Total: Exceptional changes to Table B (to be approved by e-mail or signature by the student, the responsible person in the Sending Institution and the responsible person in the Receiving Institution) Table B2 During the mobility Component code (if any) Component title at the Sending Institution (as indicated in the course catalogue) Deleted component [tick if applicable] Added component [tick if applicable] Confirmed component Number of ECTS credits (or CFU) Total: Signatories Name Email Position Date Signature Student Student Delegato all’internazionalizzazione di Dipartimento at the Sending Institution Academic Coordinator Responsible person at the Receiving Institution
allegati257978.docx