(Annesso Allegato n. 2 – WORK PLAN PRELIMINARE CON ACCETTAZIONE DA SEDE)

ERASMUS PLUS PROGRAMME KEY ACTION 1
STAFF MOBILITY FOR TRAINING 2017/2018

WORK PLAN PRELIMINARE 
(candidato in possesso di accettazione da sede estera)

APPLICANT	
Name and Surname
		
Telephone and e-mail 	0039 + 	
Age:                                                     Gender: □  Male □ Female	
Home Institution: 

Erasmus code:	Sapienza Università di Roma
Piazzale Aldo Moro, 5
00185 Roma

I ROMA01	
Office/Department/Unit		

HOST INSTITUTION	
Name of the host institution:	
Erasmus code:	
Host Department/Office/Unit:	
Town/City:                                                                                     Country:	
Contact person (name, surname, telephone, e-mail):
	
Position:	

MOBILITY PERIOD    
FROM:                                 TO:       
(between 2 and 5 days) 
	
NUMBER OF DAYS:	

Overall aim and objectives of the mobility:

	

Type of activity to be carried out : 

□ Job shadowing 

□ Staff Mobility Week 

□ Other_____________________	

Activities to be carried out and, if possible, the programme for the period (in case of Staff Mobility Week, please attach the programme of the event):

	

Language of the staff training period :

Expected results:

	

Authorisation from the Home Institution

Sapienza Università di Roma

Name :
Position:
Date:

Signature:

Applicant’s name

Signature:

Date:	
Authorisation from the Host Institution:

Name:
Position:

Date:

Signature: