Department of pharmaceutical and pharmacological sciences
Master Degree in Pharmaceutical Biotechnologies
Application form of thesis internship 
This form must be submitted duly filled and signed to the Didactics Office at least 15 days before the expected beginning date of the thesis internship for approval by the Chair of the Master Degree Course in PharmBiotec.
Students must have been awarded at least 50 credit points in order to submit their thesis internship application.

I, the undersigned _________________________________________________________________
enrolment nr. ______________ born in ____________________________ the_________________
Address _______________________________________________ Phone nr.________________
E-mail _______________________________________________________________________
Street __________________________________________ Phone nr. ________________________
Enrolled in the year _________ of the Master Degree in Pharmaceutical Biotechnologies, communicates to be in agreement with Prof. _______________________to carry out the thesis internship in the research laboratory.
I, the undersigned states to have been awarded ____ CFU and to have taken successfully nr. ____ 
educational activities (exams) as listed below, with the purpose to begin the thesis internship
starting from the date  ___________________________________________________________

□ I, the undersigned states to carry out all/part of my thesis internship during the Erasmus period, at the University  ________________________ (Erasmus CODE ___________________)
Date of departure ______________________________________

Padova ______________________							SIGNATURE

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I, the undersigned Prof. ____________________________ declares to accept the student ______________________________________for the thesis internship as thesis Supervisor.

Notes ___________________________________________________________________________
_______________________________________________________________________________

Padova ______________________						SIGNATURE

Department of pharmaceutical and pharmacological sciences
Master Degree in Pharmaceutical Biotechnologies
Application form of thesis internship 
List of CFU and educational activities (exams) carried out by the student______________________
enrolment nr. __________________ enrolled in the year _________ of the Master Degree in Pharmaceutical Biotechnologies
Educational activities	Mark	CFU	Educational activities	Mark	CFU

						

						

						

						

						

						

Padova ______________________						SIGNATURE