Application form

Academic year (mobility year):

Mobility Type:

Country:

City:

Name of the home institution:

Title:

Name:

Family name:

Date of birth:

Seniority in the position:

Nationality:

Address (official address in full):

Department/unit (at home institution):

Phone:

E-mail:

Sex:

First day of teaching or training at NCU:

Last day of teaching or training at NCU:

I apply for a lump sum for travel cost, which is a fixed amount based on the distance between your home institution and NCU calculated by Distance calculator for organisations ( https://erasmus-plus.ec.europa.eu/resources-and-tools/distance-calculator):

yes
no

I declare that the travel will take place on a different day/days than the days of implementing the physical mobility program:

yes
no

Main means of transport:

airplane
car / motorcycle (1 person traveling)
ship / ferry
train
bus
carpooling (at least 2 people traveling together: https://en.wikipedia.org/wiki/Carpooling)

Regarding standard travel (airplane, ship/ferry, car/motorcycle – 1 person), max. 2 days can be funded (1 day before and 1 day after the mobility). I apply for a scholarship for:

one travel day (1 day before the mobility OR 1 day after the mobility)
two travel days (1 day before the mobility AND 1 day after the mobility)

I declare to travel to the host university - NCU (both ways/in two directions) using low-emission means of transport (“green travel”: bus, train or carpooling):

In case of green travel, a separate declaration needs to be submitted (Declaration of planned “green travel”).

yes
no

Date of arrival at NCU:

Date of departure from NCU:

"Recruitment Protocol" signed (pdf only):

"Mobility Agreement" signed by three parties (pdf only):

I have read the privacy policy and I agree to processing my personal data.

NICOLAUS COPERNICUS UNIVERSITY IN TORUŃ

Travel