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/ / / 8 g \ \ / sM < ( G ( o o o L L L L L L L $ R eU L L o o 4 M & # # # o o L # L # # R LG 0I o $d p @H L 7M < sM ^H -V ! -V < 0I 0I -V I 0 " # L L ! ` sM -V Y : UNIVERSITA DEGLI STUDI DEL SANNIO - UNITA ORGANIZZATIVA INTERNAZIONALIZZAZIONE, MOBILITA
Pizza Guerrazzi, 1 Palazzo San Domenico 82100 BENEVENTO (ITALY)
( + 39 0824- 305453; ( HYPERLINK "mailto:relint@unibas.it" erasmus@unisannio.it, P.E.C. HYPERLINK "mailbox://C:/Documents%20and%20Settings/mottola/Dati%20applicazioni/Thunderbird/Profiles/e631pimz.default/Mail/Local%20Folders/contatti/pec.html" amministrazione@cert.unisannio.it
DOMANDA DI PROLUNGAMENTO DEL PERIODO DI MOBILITA ERASMUS a.a. 2023/2024
(ERASMUS MOBILITY PERIOD EXTENSION REQUEST FORM a.y. 2023/2024)
Il/La sottoscritto/a (I, the undersigned,)
Nome e cognome studente in mobilit
(Students full name):________________________________________________________________________
Universit di appartenenza (Home University): UNIVERSITA DEGLI STUDI DEL SANNIO - I BENEVEN 02
Iscritto al corso di studi (Degree course): ________________________________________________________
Universit ospitante (Host University): __________________________________________________________
Codice Erasmus (Erasmus code): _____________________Durata del periodo di mobilit: dal __/__/____ al __/__/____ per un totale di n. __ mesi.
(Erasmus mobility period: from date__/__/____ to date__/__/____ Total no. months ___)Chiede un prolungamento del periodo Erasmus
(request an Erasmus mobility period extension)
Numero mesi di prolungamento richiesti
(Number of months requested for extension period):Numero mesi complessivi della mobilit, compresi quelli inizialmente assegnati
(Total number of months of mobility period (Original period + extension period):Periodo di mobilit complessivo
(Total mobility period: from date/to date): dal __/__/____ al __/__/____Per i seguenti motivi (si prega di indicare i motivi sia in lingua italiana che in lingua inglese)
For the following reasons (please state reasons in both English and Italian):
____________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Il sottoscritto consapevole che il contributo finanziario per il prolungamento sar corrisposto compatibilmente con le risorse disponibili, ma che lo status di Studente Erasmus sar garantito per lulteriore periodo.
(I hereby confirm that I am aware that a financial contribution for the extension will only be given if there are available funds, but that Erasmus status will be guaranteed for extended period.)
_________________________ ________________________________________
Luogo (Place) e Data (Date) Firma dello studente (Students signature)
ACCEPTANCE BY THE HOST INSTITUTION
Position: _________________________________
Signature: ________________________________
Date: ____________________________________
Stamp: ACCEPTANCE BY THE DEPARMENTALS COORDINATOR AT THE UNIVERSITA DEGLI STUDI DEL SANNIO
Valutate le motivazioni dello studente sopra indicato, esprimo parere favorevole al prolungamento del periodo di mobilit. (After careful consideration of the students above mentioned motivations, I hereby agree to the Erasmus period extension.)
Signature: ____________________________________
Date: ________________________________________
Stamp:
HYPERLINK "http://www.erasmusplus.it" INCLUDEPICTURE "http://www.erasmusplus.it/wp-content/uploads/2014/01/logo_e+.png" \* MERGEFORMATINET
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