– Teaching Office, Palazzo Vendramin dei Carmini
Dorsoduro 3462 30123 Venice, Italy –

International Exchange Outgoing Student
LEARNING AGREEMENT FOR RESEARCH ACTIVITIES	

	

Please fill in the form and send it to the Teaching Office of the Department of Asian and North African Studies, by fax (+39 041 234 9521) or by e-mail (internazionale.dsaam@unive.it). The student has also to submit the original form by hand or by registered letter to the Teaching Office of the Department of Asian and North African Studies within 15 days from the end of the Exchange mobility period.

DETAILS OF THE PROPOSED STUDY PROGRAMME ABROAD/LEARNING AGREEMENT
Research activities for the degree thesis

Academic year	______________________	Semester	______	Matriculation number	__________	
Student’s name	______________________	Student’s surname	_____________________________	
Department	______________________________________________________________________	
Sending institution	_Università Ca’ Foscari Venezia______________	Country	_Italy_________________	

Hosting Institution		Country		

Description of the research activities for the degree thesis:	
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________	

Student’s signature		Date (dd/mm/yyyy)		

SENDING INSTITUTION:
We confirm that the proposed learning agreement is approved.	
______________________________
Academic contact person’s signature
__________
Date (dd/mm/yyyy)	
HOSTING INSTITUTION:
We confirm that the proposed learning agreement is approved.	
______________________________
Academic contact person’s signature
__________
Date (dd/mm/yyyy)