INTERRUPTIONS, EXTENSIONS OR TRANSFERS FORM	

Herewith, the undersigned ________________________________________________   student -  graduate of the Degree Course in _______________________________ internship period from __________ to __________ at ___________________________, in agreement with the Company Tutor _____________________________, asks to vary the following with respect to their initial internship project: 
o	Extension till _________ for the following reasons:
_________________________________________________________________ ________________________________________________________________;
o	Pre-term interruption as of _________;
o	Trasfer date _________ to __________________________________ by means of __________________________________.

o	Requests that notice that the above changes to the internship have been accepted and registered will be made to the following email address ___________________________________.

Place, date _______________________

Intern Signature

____________________________	Company Tutor Signature

____________________________