Confirmation of Departure 2017/2018

Our Ref: Student Details

Student SurnameStudent first Name

Date of BirthMobility Type

Host OrganisationStart Semester

Duration in Semesters

Host Organisation Signatory Details

Surname

First Name

Position

Department

email

I, the above mentioned signatory confirm that the student, , will depart our

organisation on the______________________ (date).

The final duration has been a total of ________ months.

Signature ____________________________________

Date ____________________________________

Please note:

1. This form should be completed by your contact just before you depart the host organisation.2. Please ask your contact for the earliest date this form will be completed for you.3. The form must be completed in full, incomplete forms will be returned.4. The end date should be a date of the last day of exams, or final assignments submitted.5. The end date can positively or negatively influence the final grant amount you will receive.6. Please ensure the date that is entered is your final date in the host organisation, as this cannot

be amended later.7. Completed forms should be submitted

a. in PDF or Word format by email to erasmus@dit.ie onlyb. Hard copies sent to DIT International Office, 40-45 Mount Joy Sq, Dublin 1

Stamp: