– International Relations Office, Ca’ Foscari University of Venice,
Dorsoduro 3246, 30123 Venice, Italy –

Erasmus+ Outgoing Student
CONFIRMATION OF DEPARTURE	

Annex 3, p.2 	

Please fill in the form and return it to the students, who has to hand in the original form to the International Relations Office of Ca’ Foscari University of Venice within 15 days upon his/her return.

Academic year	______________________	Semester	______	Matriculation number
(Ca’ Foscari)	__________	
Student’s name	______________________	Student’s surname	_____________________________	
Sending institution	_Università Ca’ Foscari Venezia______________	Country	_Italy_________________	
Number of months of the Erasmus scholarship	_______________________________________________	

HOST  INSTITUTION:
Name and full address	
_______________________________________________________________________________________	
_______________________________________________________________________________________	
International Relations Officer – name and surname, tel., fax, email	
_______________________________________________________________________________________	
_______________________________________________________________________________________
	
DATE OF DEPARTURE
from the host institution (dd/mm/yyyy):	___________________________________________	

Student’s signature

__________________________________________
	
International Relations Officer
of the host institution: signature and stamp

_________________________________________
	
Date (dd/mm/yyyy) ___________________________	 Date (dd/mm/yyyy) __________________________