Erasmus Teaching Mobility s1
TEACHING PROGRAM /
Please fill in this program electronically before printing
Personal Data
Mr Ms / Family Name: / Forename(s):
Nationality: / Turkish ID Number (or passport number for foreign faculty):
Date of Birth: / Subject Area:
Staff with disabilities (Yes/No) / If yes, we invite you to disclose this information so that your needs can be addressed and you can apply for an additional grant in order to cover the extra costs which may occur during your Erasmus+ mobility.
Seniority:
Lecturer/Research Assistant Junior (Assist. Prof.)
Intermediate (Assoc. Prof.) Senior (Professor)
E-mail Address:
Phone Number(s):
Fax Number (if there is any):
Home Institution
Name of the Home Institution / Istanbul Kemerburgaz University
Erasmus ID Code / TR ISTANBU38
Faculty and Department:
Institutional Erasmus Coordinator / Senay Gumus
Contact Details of the Institutional Erasmus Coordinator / E-mail Address:
Phone Number: 00 90 (212) 604 01 00
Host Institution
Name of the Host Institution
Erasmus ID Code
Faculty and Department
Name of the Contact Person
Contact Details of the Contact Person at the Host Institution / E-mail Address:
Phone Number:
Content of the Teaching Activities
Level of Teaching / BA MA/MS/MBA PhD
Number of Students Benifiting from the Teaching Activity / Approximately
Period of the Mobility (arrival and departure dates)
Number of Teaching Hours
Language of Teaching
Objectives of the Mobility:
Added Value of the Mobility (both for the host institution and for the faculty):
Expected Results (not limited to the number of students concerned):
Daily Program of the Teaching Activities
You can add as many lines as needed by pressing the ENTER key in each column
Date / Subject / Hours
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This teaching program must be approved by both the sending and the host institution.
Faculty’s Signature:______Date:Home Institution : We confirm that the above proposed teaching / work plan is approved.
Head of the Department
Name:
Signature:
Date: / Institutional Erasmus Coordinator
Name: Senay Gumus
Signature and Stamp:
Date:
Host Institution: We confirm that the above proposed teaching / work plan is approved.
Institutional Erasmus Coordinator
Name:
Signature and Stamp:
Date: