Application for an Extension (Outgoing Students)

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Application for an Extension (Outgoing Students)
of an Erasmus Mobility for the Academic Year

Student’s Personal Data
Name, first name
E-Mail
Home Institution	Philipps-Universität Marburg (D MARBURG01)
Host Institution
Initial duration	From to
Extension	From to

I hereby apply for an extension of my ERASMUS mobility stay abroad, and for an extension of my ERASMUS mobility grant according to the regulations of Philipps-Universität Marburg.

Reasons:
I am aware that an application for an extension has to be submitted at least one month before the end of the originally granted mobility period.

I am aware that the extension is only valid once a new Grant Agreement and a Learning Agreement have been signed by all parties for the extended period.

Date (Student´s Signature)

1. Host Institution

(Seal and Signature)

2. Home Institution

(Departmental Co-ordinator)

(Seal and Signature)

3. Home Institution

(Institutional Co-ordinator)

(Seal and Signature)

This certificate is part of the documentation of the ERASMUS Mobility of the student. The original document will be kept by the International Office of the home institution.