Confirmation of placement period


I.                     Details of the Student

                 Name of the student: ………………..…

                                                          Country: CZECH REPUBLIC

                 Home university: MASARYK UNIVERSITY

                                                          Academic Year: ………………..…

                 Home university field of study: ………………..…


                                                          Degree: ………………..…


II.                   Details of the HOST University/ Institution

Host university/institution: ……………………………………..…..........(in English)

Country: ………………..………………..(in English)

Faculty/department: ………………..…

Postal Address:




III.                 Confirmation of Placement period

This is to certify that the student mentioned above has carried out a practical/study placement in
our institution. / Tímto potvrzujeme, že výše zmíněný student absolvoval pracovní/studijní pobyt
v naší organizaci

From/ od _____/_____/__________(dd.mm.yyyy)   to/ do _____/_____/__________(dd.mm.yyyy)

Mobility type:                                         □ physical               □ virtual
only          □ blended (physical & virtual)

Physical part in case of blended mobility

From:             /         /           to              /                /



IV.                 Confirmation FROM THE HOST University/ Institution

   Coordinator’s name/ Responsible person name:


                                               Date: …………………(dd.mm.yyyy)

                                               Signature: ………………..…

                                               Stamp:




   We would like to continue the cooperation with Masaryk University and offer intership for its
   students:   yes,   no.


Confirmation must be signed within maximum of five (5) days before final date of student´s stay.