(Please copy or photocopy this page
onto your own headed paper)

TRAINEE rEQUEST Form

Company details

Company name :	

Director:	

Address (street/town/postcode/country) :	

	

Tel:		Fax:	

e-mail:		Internet site	

Activity of enterprise

Type of enterprise (you may tick more than one box):

	r  Public or state-owned enterprise	
	r Multinational 	
	r Small and medium sized enterprise (less than 250 workers)
	r Large enterprise
	r Chamber of Commerce / Industry / Trade
	r Other (please specify)	

Sector of activity

	r Production	
	r Construction
	r Commerce / service	
	r Agri-food
	r Banking / insurance
	r Other (please specify)

Has the company hosted student-trainees under the LEONARDO DA VINCI programme of the European Union in previous years?

	  Yes 	  No 

PROFILE OF CANDIDATE REQUIRED

Type of Degree	

Required level of studies (n° years completed)	

Main subjects studied	

			

Other skills and characteristics required		

			

Placement duration (in months)    Minimum		Maximum	

Period within which the placement should start:		

Preferred language skills:

1	beginner (  )	intermediate (  )	advanced (  )

2	beginner (  )	intermediate (  )	advanced (  )

3	beginner (  )	intermediate (  )	advanced (  )

Location of placement

Department where placement will take place:	

Town and country: 	

Contribution of company to grantee (tick as appropriate):

		a monthly payment of ______________ 
		subsidised meals
		travel costs to/from the workplace
		accommodation (please specify) 
		other (please specify)
		no contribution

Description of placement activities

(1)  Project(s) in which the grantee will be included

	

	

	
(2)  Role of grantee in these projects (level of autonomy / responsibilty)	

	

	

	
(3) Objectives of the exchange (list the skills the grantee might bring to the workplace and how the company may enrich or add to these)

	

	
	
                                                                                                                                       (use a further sheet if necessary)

Contact person

First name :		Family name :	

Position :	 	Extension number :	

Signature:	  Date:	

Please return to:
SINTESI University Enterprise Training Partenrship		Tel +39 091 6572222
c/o Dip. Di Ingegneria Chimica dei Processi e dei Materiali	Tel +39 091 6571654
Università degli studi di Palermo		Fax +39 091 6571655
90128 Palermo, Italy	http://sintesi.dicpm.unipa.it	e-mail:  sintesi@www.unipa.it