MASARYKOVA UNIVERZITA

OFFICE FOR INTERNATIONAL STUDIES

Application for extension of Erasmus stay from the autumn to the spring
semester of the academic year 2009/2010
(! Please note that it is not possible to extend the Erasmus stay from the spring to the autumn semester!)

Hereby, I …………………………………………... from
………………………………………………
(name of student)

(name of home university)

apply for an extension of my exchange period abroad. I am currently studying at the Masaryk
University (Brno, Czech Republic) within the Erasmus exchange programme.
Original exchange period (autumn semester):
…........ (… months)
New exchange period (spring semester):
(… months)

From …. /…. / …........ until …. / …. /
From …. / …. / …........ until …. / …. / ….......

………………………………………………………
………………………………………………..
Date, Signature (of the student)

Name of HOST UNIVERSITY :
Departmental Coordinator:
Department/Faculty:
..

Masaryk university
..........................................................................
........................................................................
………………………………………………………
………………………………………………..
Date, Signature (of the departmental co-ordinator)
Erasmus Coordinator:
Marcela Dibelková
The Institution agrees
□Yes
□No
Phone:
+ 420 549 49 3264

Fax:

+ 420 549 49 1113

………………………………………………………
………………………………………………..
Date, Signature, Stamp (of the receiving institution)

Departmental Coordinator:

Name of the HOME UNIVERSITY:
..........................................................................
..........................................................................
Erasmus Coordinator:
..........................................................................
The Institution agrees
□Yes
□No
Phone:
Fax:
………………………………………………………
………………………………………………..
Date, Signature, Stamp (of the sending institution)

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