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

Erasmus+ Outgoing Student

APPLICATION FOR EXTENSION OF THE MOBILITY PERIOD	

Annex 4 

Please fill in the form and send it to the International Relations Office of Ca’ Foscari University of Venice by email (erasmusout@unive.it) or by fax (+39 041 234 7567). 

The undersigned (student’s name and surname) 
_________________________________________________________________________________ 

Erasmus student from Ca’ Foscari University of Venice at (name of host Institution)
__________________________________________________________Erasmus Code___________

hereby ask for an extension of his/her Erasmus+ mobility period in order to conclude the activities he/she is carrying out at the host University (please specify such activities, i.e: exams,  research activities)_______________________________________________________________________

Date of beginning of Erasmus+ stay (as in the Confirmation of Arrival): ________________________
Expected duration of the Erasmus+ mobility (in months): ___________________________________
Month of extension requested (from the expected end of Erasmus mobility): ____________________

The undersigned is aware that the extension of his/her Erasmus+ mobility period might not be financed. 
Appropriate changes to the learning agreement are enclosed to this form. 

Date (dd/mm/yyyy)______/_____/______

Student’s signature 			

-----------------------------------------------

Coutersigned by

Stamp and signature
of the Erasmus+ Coordinator
at Host University

______________________________________
	
Authorized by

Stamp and signature
of the Erasmus+ Coordinator
at Home University

______________________________________