Application Form and Work Plan

Application Form and Work Plan

foroutgoing ERASMUS+ Administrative Staff Mobility

in the academic year 2016/2017

to be submitted to:Mobility Department of the International Relations Directorate of UP

(Vasvári P. u. 4)

personal details:

Name:

/

Nationality:

Name at birth:

Place of birth:

/

Date of birth:

Permanent address:

Name of Faculty and Institute/Department or organisational unit:
Position:
Workplace phone number: / Mobile phone number:
E-mail account:
Name of direct superior: / Position:
Phone number: / E-mail account:

Planned ERASMUS mobility activity

Particulars of the host institution:

Name of the host institution:
Erasmus code of the host institution (if it has one):
Address of the host institution:
Name of the contact person at the host institution:
Position:
Phone number:
E-mail account:
Particulars of the mobility activity:
Short description of the planned activity (agreed on with the host institution and approved by the direct superior):
How many days do you apply for? / Number of days: ______
Time of travel
(day, month, year)
Have you participated in a mobility programme before? If yes, when and in the framework of which programme and with what activity?

Motivation:

To what extent do you expect the mobility activity will contribute to the improvement of the activities of the sending organisational unit?
To what extent will the mobility activity contribute to your own professional development?
To what extent will the mobility activity enhance the quality and volume of the Erasmus mobility and the improvement of the quality of related services?
What results do you expect from the mobility activity?
How do you plan to share the experience gained during the mobility with your colleagues working in a similar field?

Calculation of costs and expenses:

My costs and expenses: / Amount:(Euro)
Travel: / Means of travel:
Accommodation: / Number of nights: / Accommodation per night:
Participation fee: / Registration fee: / Participation fee:
Daily subsistence:
Altogether:

Date:Signature:

…………………………………

Reference by the direct superior:

…………………………………………

Signature

(direct superior)

Attachments:

Attachment no.1 – Professional CV with photo;

Attachment no. 2 – Language exam certificate(s)

Attachment no. 3 –Work Plan or Study Plan agreed on with employer and with therepresentative of the receiving party