APPLICATION[1]for REFUNDING COSTS of

INTERCULTURALEVENTS

Applicant’s data

group
names[2]
Address
Telephone
Email

Event/Project

Theme
Date
Place
What and why in 1-3 short sentences
participants[3] / studentsin sum: ; of which internationals: see list attached
Estimated Costs[4]
type / short description / €
Room rental / 0,00
Technique rental / 0,00
Food[5] / 0,00
Entrance fees / 0,00
Travel / 0,00
Other / 0,00
Sum / 0,00
If an advance payment is requested (over 200€), please fill in: (not applicable for eingetragene Vereine)
account holder:² / Ms/Mr surname, given name
private address: / street, house no., post code, city
bank:
IBAN:
BIC:
Final declaration
I hereby declare to use the funds as described above and hand in the final declaration of costs, including original receipts/bills and account statements no later than 14 days after the event. I understand that I alone should handle the funds, payments and final declaration.
Jena, (date, signature)

LIST of Participants

Please attach to the „Application for Financing an Intercultural Activity”.

Nr / Name / Status[6] / Signature
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

If there were more than 20 participants, please indicate surplus number:____

[1]The application must be submitted to the International Office at least one month before the event. Applications may be submitted only until 30 November.The refund report includes a short summary and the original receipts (bills must be accompanied by a proof of payment).

[2]Groups and associations must name a responsible natural person.

[3] At least 50% or at least 10 of the participants must be international students.

[4] Maximum sums: guided tours 50€/hour; day excursions: 20€/day per participant; parties/breakfasts etc: 2€/participant. There is no legal claim to the possible maximum sum.

[5]Applications must not be made for alcoholic drinks, accessoires or items for long-time use, insurance costs, deposits (Pfand), gifts.

[6] Status: FSU student; FSU staff; external