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

Erasmus+ Outgoing Student

APPLICATION FOR EXTENSION OF THE MOBILITY PERIOD	

Please fill in the form and send it to the International Relations Office of Ca’ Foscari University of Venice by email (erasmusout@unive.it) 

I, 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 my Erasmus+ mobility period in order to conclude the activities I am 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 as per Grant Agreement (in months): _______________
Month of extension requested (from the expected end of Erasmus mobility): ____________________

I am aware that the extension of my Erasmus+ mobility period might not be financed. 
Relevant changes to the OLA are enclosed to this form. 

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

Student’s signature 			

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

Countersigned by

Stamp and signature
of the Erasmus+ Coordinator
at Host University

______________________________________
	
Authorized by

Stamp and signature
of the Erasmus+ (departmental) Coordinator
at Home University

______________________________________