APPLICANT’S DETAILS		
Surname 

(as indicated in Passport or Identity card)	First name:

(as indicated in Passport or Identity card)	
Date of birth: (dd/mm/yyyy)	City and Country of birth:	
Nationality:	Gender: (M/F)	
Home Address: 
(please indicate your full address: Address, Town, Post/Zip Code)		
Document: (passport or ID card)	ID card or passport number 
Date of Expiry	
Telephone Number:
Mobile Number:	E-mail Address:	
Do you require Disability or Learning Support?     	Yes ☐     No ☐	

HOME UNIVERSITY		
Home University:		
Current position at the partner university 		

Compulsory attachments:

●	Application Form: Duly completed and signed by the applicant (using the template provided on the call’s webpage).
●	Mobility Programme: Completed and signed by the applicant and the Head of the applicant’s academic unit/department/faculty (using the template provided on the call’s webpage).
●	Identification: A clear copy of a valid passport.
●	Certificate of Employment: An official certificate issued by the sending institution confirming the applicant's current academic staff status and his/her involvement in the teaching of Italian as a foreign language.
●	Language Proficiency: Copies of official language certifications (if available) or a self-declaration of language proficiency included within the Mobility Programme (refer to section "Language Skills").
●	Curriculum Vitae (CV): A CV in English (maximum 2 pages), detailing academic qualifications, extra-curricular activities, and professional experience relevant to the mobility field. 

SIGNATURE OF APPLICANT		
I confirm that the information provided on this application form is correct.		
Signature: 

	Place and Date: