MASTER IN ADVANCED MOLECULAR SCIENCES (LM 54)

APPLICATION FORM FOR “Internal Research Activity”
Name and Surname: ______________________________________________________
Registration Number_______________________________________________________
Place and date of birth: ____________________________________________________
Address: ________________________________________________________________
Telephone number_________________________________________________________
Email address : __________________________________________________________
ASKS
To the Board of the Master to carry out the thesis work at (specify the Organization/Department) ______________________________________________________________________________
Internal Activity Topic: _______________________________________________________________________________
Internal Activity Title: ____________________________________________________________________
The experimental work will be supervised by Prof./Dott.: __________________________
Student’s Signature____________________Tutor’s Signature __________________________
Date ________________

On the date ............................... the Board of the Master in Advanced Molecular Sciences has approved  the request and has appointed Prof./Dott. ......................................................Tutor of the internal activity work to be carried out by the student...................................................................