ACADEMIC YEAR 2012/2013 REQUEST FOR ACCOMMODATION IN THE A.DI.S.U.

HALLS OF RESIDENCE
Please print in block letters

Surname:Andreea First Name: Eremia Address: Colonel Ion Buzoianu,5 Mobile:
0746143265

Sex:F

E-mail:deea300490 @yahoo.com Home University:

(example: Universitatea Politechnica din Bucuresti) Universitatea de Stiinte Agronomice si Medicina Veterinara din Bucuresti

Date of Arrival in Perugia:
03.09.2012

Date of Departure from Perugia:
26.02.2013 (If known)

Name of Erasmus Coordinator in Perugia:

Tiziano Gardi

Student Signature:

Date:

Incoming Student Mobility Office Università degli Studi di Perugia Fax number: +39 075 5733480 Tel Number. +39 075 5738926 – 075 9669273