Transnational Education - TNE
Mobility Programme – Teaching Staff

Planned period of the teaching activity (travel days excluded): 
from [day/month/year]		
till [day/month/year]		

Action under which you are submitting your application (as for art. 2 of the call, Column Action within the tables): 

The Teaching Staff Member
Last name (s)		First name (s)		
E-mail				
Department				

The Sending Institution 
Name of Sending
Institution				
Country				
City				
Name of sending
Department/Faculty				

 Proposed mobility programme
Content of the teaching programme (proposed workplan):

	
Motivation:

	
Expected outcomes and impact (both on the professional development of the teaching staff member and in the context of modernisation and internationalisation strategies of the institutions involved, at regional and national level):

	
Language Skills:

	

The teaching staff member
Name:
Signature: 	Date:		

The sending institution
Name of the responsible person:
Signature: 		Date: