Annex n.1

To the Rector 
Università degli studi di Modena e Reggio Emilia

APPLICATION FORM 
VISITING PROFESSOR 

Visiting Professor Data: 
Name		
Surname		
Place and date of birth		
Nationality		
Address		
Country		
E-mail		
Home Institution		
Department/Faculty		

Position	⁭ Full professor           □

⁭ Associate professor  □

⁭ Researcher                   □	

Visiting Professor at the University of Modena and Reggio Emilia in the previous calls 	⁭ Yes  □
   
⁭ No         □	
Teaching activity to be carried out in the host institution (title and description)	Fill in…	
Proposed length of stay	a.y. 2016/2017:

3 full months
□ 1st  Semester                   □ 2nd semester  

Approximately From…………………to…………………….	
Reference
(indicate which profile your application refers to)		

Applicant’s documents:
-	curriculum vitae of the candidate including a list of the 5 most important publications/monographs within the last 5 years, and/or a list of the candidate’s speaking engagements at international conferences;
-	proposal of the teaching activities.

Date, 

Signature of the Applicant  (visiting professor)