During the Mobility

Student’s Name_____________________

 	Exceptional changes to Table A
(to be approved by e-mail or signature by the student, the responsible person in the Sending Institution and the responsible person in the Receiving Institution)	
Table A2
During the mobility	Component code 
(if any)	Component title at the Receiving Institution
(as indicated in the course catalogue) 	Deleted component
[tick if applicable]	Added component
[tick if applicable]	Reason for change	Number of ECTS  credits (or equivalent)	
 	 	 	☐	☐	Choose an item.	 	
 	 	 	☐	☐	Choose an item.	 	
			☐	☐			
			☐	☐			
			☐	☐			
			☐	☐			

 	Exceptional changes to Table B (if applicable)
(to be approved by e-mail or signature by the student and the responsible person in the Sending Institution)	
Table B2
During the mobility	Component code 
(if any)	Component title at the Sending Institution
(as indicated in the course catalogue) 	Deleted component
[tick if applicable]	Added component
[tick if applicable]	
Number of ECTS credits (or equivalent)	
 	 	 	☐	☐	 	
 	 	 	☐	☐	 	
			☐	☐		
			☐	☐		
			☐	☐		
			☐	☐		

      Signature of the Departmental Coordinator (home institution)______________________________________

      Signature of the Departmental Coordinator (host institution)_______________________________________

      12 Reasons for exceptional changes to study programme abroad (choose an item number from the table below):
Reasons for deleting a component	Reason for adding a component	
1. Previously selected educational component is not available at the Receiving Institution	5. Substituting a deleted component	
2. Component is in a different language than previously specified in the course catalogue	6. Extending the mobility period	
3. Timetable conflict	7. Other (please specify)	
4. Other (please specify)