Padua,

To the Coordinator 
PhD Program in Biomedical Sciences
Prof. Fabio Di Lisa

I hereby declare that the PhD Student ………………………………………………….., will be supervised by myself (………………….…………………………… as  co-supervisor, ……………………………………………………. as Faculty advisor).
S/he will carry out the research activities on (title of PhD program)  …………………………………………………………………………………………………………………….…………………..……..…………………………………………………………………..in my laboratory at (specify location or locations) …………………………………………………………………………………………………………

Faithfully

………………………………………………
(supervisor)

………………………………………………
(PhD Student)