BILATERAL agreement oF cultural AND SCIENTIFIC cooperation
STUDENT MOBILITY PROPOSAL
ACADEMIC YEAR 2021/ 2022
ANNO ACCADEMICO

FIELD OF STUDY: LAW

photo passport fomat	
This application should be completed in BLACK in order to be easily copied and/ore-mailed.
Si prega di compilare questa domanda in NERO per facilitarne la copiatura e/o la trasmissione via e-mail
n.b.: SCRIVERE IN stampatello o a macchina
	HOME INSTITUTION
Name and full a ddress:..........................................................................................................................................
..............................................................................................................................................................………………..
International Relations Office:………………….............................................................................................................
telephone: ....................................................................e-mail:…............................................................................
Coordinator of the Bilateral Exchange Agreement.................................................................................................
telephone: ....................................................................e-mail:…............................................................................
COORDINATOR’S SIGNATURE ……………………………………………………………………………………………………………………………..
STAMP OF THE HOME INSTITUTION or International Office 	
	STUDENT’S PERSONAL DATA
Family name: .......................................................First name(s): .........................................................Sex: F □ M□
Cognome	  NomeSesso
Date of birth: ............................ Place of birth: ............................................ Nationality:......................................
Data di nascita                               Luogo di nascita                                               Cittadinanza

Current address: ........................................................  Permanent address (if different): .....................................
..............................................................................................................................................................………………..
..............................................................................................................................................................………………..
Tel.: ........................................................................... e-mail.:.................................................................................	
	Host Institution
Istituzione ospitante

Università degli Studi di FIRENZE
School of Law	
Country
Paese  

Italy	period of study
periodo di studio

from (da)          to (a)  
	Stay (months)
soggiorno (mesi)

.........................	expected credits
crediti previsti

............................	

 	Name of student: ...............................................................................................................................................°
Nome e cognome dello student
	
Registration N. at the Home University 
N° di matricola
	
Main reasons why I wish to study abroad:
Principali motivi dello studio all’estero
..............................................................................................................................................................………………..
..............................................................................................................................................................………………..
..............................................................................................................................................................………………..
if necessary, continue on a separate sheet	
	CURRENT AND PREVIOUS STUDY
STUDI  ATTUALI  E  PRECEDENTI 
Iscritto(a) al Corso di laurea/diploma in 
Diploma/degree for which I am currently studying: ............................................................................................
Durata legale del corso
Duration of course: ...................years………..Years of study prior to departure abroad : .....................................
	
I have already been studying abroad.                                                     Yes         No  
Precedenti soggiorni di studio all’estero
If Yes, when? .................................................................	
Se si, quando?
At which institution?......................................................................................
Presso quale istituzione?	
	WORK EXPERIENCE RELATED TO CURRENT STUDY (if relevant)
ESPERIENZE DI  LAVORO (se rilevanti ai fini degli studi intrapresi)

Type of work experience               Company / organization                    dates                           country
Tipo di lavoro svolto                               Ditta / Ente                                           periodo                           paese
..............................................................................................................................................................………………..
..............................................................................................................................................................………………..
..............................................................................................................................................................………………..	
LANGUAGE COMPETENCE
CONOSCENZA LINGUISTICA
	Livello di conoscenza
proficiency
Languages/Lingue straniere	Mother tongue
Lingua madre	Excellent
Ottima	Good
Buona	Fair
Media	
	Italiano	            	             	             	             	
I	English	            	             	             	             	
	Français	            	             	             	             	
	Deutsch	            	             	             	             	
	 Español	            	             	             	             	
	Other: .........................	            	             	             	             	
	Other: .........................	            	             	             	             	

Language of instruction at home institution (only if different from mother tongue) …………………………………………..…………….
Lingua di insegnamento nell’università di origine (solo se diversa dalla lingua madre)

Data			Firma ___________________________________