Centre for International Affairs
2 Emanuil Chakarov Str. , 5250 Svishtov, Bulgaria
+ 35963166440 ;
applicant’s full name
Academic year 20…/20…
applicationform
for staff exchange
(academic year 20…./20….)
exchange programme details
Exchange programme: / Erasmus+ mobility programme / other exchange programme / inter-institutional exchange agreement
Requested duration of mobility: / from [dd/mm/yyyy] till [dd/mm/yyy]
personal data
Surname: / First name (s):
Date of birth: / dd/mm/yyyy / Place of birth:
Nationality: / Sex: / M/F
Passport or National ID No.: / Authority:
Date of issue: / Date of expiry:
contact data
Email: / @ / Skype account:
(if any)
Facebook account:
(if any) / LinkedIn account:
(if any)
Telephone number:
(mobile phone no., incl. country code) / Viber account:
Permanent address: / Country, city, postal code, street name and number
Correspondence address:
(if different) / Country, city, postal code, street name and number
accommodation datails
Accommodation preference[1]: /
Arrival date: / dd/mm/yyyy / Departure date: / dd/mm/yyyy
professional status
Home institution:
Address: / Country, city, postal code, street name and number
Faculty: / Department:
Position / Academic rank: / Scientific degree:
Professional experience:
(years) / Field of study:
(ISCED-F 2013)
Date: / dd/mm/yyyy / Signature:
sending institution
Name and position of responsible person:
Email: / @ / Telephone number:
I certify that the above-mentioned applicant has been accepted by my institution forteaching/trainingmobility.
I confirm that applicant’s level of competence in English / Bulgarian / Russian (indicate the main language of instructions) is adequate for teaching/training abroad.
Date: / dd/mm/yyyy / Signature and stamp:
Please send the scanned copyof the completed application form to: (for Erasmus+ staff) or (for non-Erasmus+ staff). Please attach to the above-mentioned email yourindividual teaching/training programme (for Erasmus+ staffMobility agreement for teaching/training) at the D. A. Tsenov Academy of Economics that is approved and signed by your institution.
LIST OF APPENDICES
(mark with X all documents enclosed to the application form)
1. / Copyofpassport or ID card
2. / Individual training/teaching programme(for Erasmus+ staffMobility agreement for teaching/training)
3. / Other relevant documents(e.g. certificate of language competence, CV, etc.)
3.1.
3.2.
receiving institution
Name and position of responsible person: / Assoc. Prof. Marusya Smokova, Ph.D.,
Director of the Centre for International Affairs
Erasmus Institutional Coordinator
Email: / / Telephone number: / +359631 66 440
Status of student’s application: / Accepted / Not accepted
I declare that personal data collected through this application procedurewill be exclusively treated for institutional purposes.
Date: / Signature and stamp:
1
[1]If you choose the option “I need assistance in booking a hotel”, you will receive an email from the Centre for International Affairs with a list of hotels in Svishtov (price details, distance from the University campus, link to the hotel website, etc.).