Padua --/--/----/

To the Coordinator of the PhD Program in Biomedical Sciences, Prof. Ornella Rossetto
Request for Work authorization
I, undersigned/__________________________________________, enrolled/o at ______ year of the PhD Program in Biomedical Sciences, 
	
With fellowship financed by the University of Padua
	
With fellowship financed by the Department of Biomedical Sciences
	
With fellowship financed by external organization 
	
Without fellowship

I ask
The authorization to carry out 
	
A part-time/full-time job at _______________________________________________________________________________  from --/--/----/ to --/--/----/.
	
Supplementary teaching activities for n. hours ____________________ (max 40 hours), at the Bachelor’s degree course in __________________________________________________ of the Department of ___________________________________________ ______________________________________.

Even with the favourable opinion of my supervisor, Prof. ____________________________________________________, I feel that I have adequate time to carry out my training.

I further declare that the total revenue received by me in the current year within the month of ____________________________________________________ does not exceed the limit imposed by the University regulation (16,243.00 €).

PhD Student__________________
Supervisor__________________

Date of approval by the Faculty Board/Board of Directors ________________
Coordinator________________