Erasmus+ ICM Staff Grant Agreement Form

DATA DECLARATION FOR PREPARING THE GRANT AGREEMENT

Given name (as in passport)

Family name (as in passport)

Place of birth (town, country)

Date of birth (DD/MM/YYYY)

Nationality

Official address - Please provide the following data: zip code, country, town, street name, street number.

Address for notification (If different from official address) - Please provide: zip code, country, town, street name, street number.

Phone number (with country code)

Email address

Please make sure of providing an email address that you frequently use as this will be the main channel of communication between you and ELTE.

Gender

Academic year (when the mobility takes place)

Name of department at home institution

Experience in position

Subject area

FINANCIAL DETAILS

You will participate in a mobility with

financial support from Erasmus+ EU funds

zero grant (without Erasmus+ support)

ERASMUS+ TOP-UP FOR GREEN TRAVEL

Do you apply for a green travel top-up? (Available only for participants from Bosnia and Herzegovina and Ukraine. If you are coming from a different country, select "No".)

Yes

No

If yes, what means of transport do you opt for?

If you have chosen the last option, please specify it here.

Please bear in mind that if you apply for a green travel top-up, you will have to provide evidence of travelling green. Remember to keep your train/bus tickets, payment receipts or any kind of other proof (receipts from the gas station, road tolls etc.).

Number of teaching hours

Bank account number

Bank account holder's name

Bank name

Clearing/BIC/SWIFT code (Bank identification code)

Account number with IBAN-code

Currency of the Bank Account*

*When choosing from the above options, please take into account that ELTE will pay your grant support in euros. In order to avoid paying unnecessary fees, you may wish to consider opening a euro bank account or find any other favorable option for receiving the money transfer.

If you have chosen "Other", please specify

Correspondent Bank

If your local bank receives international money transfers via a correspondent bank, please provide its data here. (In case you do not have an IBAN number, it is probable that your bank can receive money transfers from the EU only via a correspondent bank. Please contact your bank for details.)

Correspondent bank name

Correspondent bank SWIFT code

Correspondent bank account number

DATES OF THE MOBILITY PERIOD

Start date of the mobility (DD/MM/YYYY)

End date of the mobility (DD/MM/YYYY)

The start date of the mobility period shall be the first day you need to be present at the receiving institution and the end date shall be the last day when you need to be present at the receiving institution. Travel days are excluded from the duration of the mobility period. Please bear in mind that the dates you provide here should be the same as those indicated on the Staff Mobility Agreement and Certificate of Teaching Activity documents. The mobility period should be no shorter than 5 days.

Number of travel days

Maximum 2 days can be required, please choose 0, 1 or 2. Travel days are supported with the same amount of daily stipend than mobility days. Thus your full Erasmus+ ICM scholarship contains: support for mobility days + travel days + one-time travel support (based on the distance between the home and host universities).

A minimum of 8 hours of teaching per week (or at least 5 days) has to be respected. If the mobility lasts longer than one week, the minimum number of teaching hours shall increase proportionally. Thus the minimum number of teaching hours is to be calculated in the following way: ‘number of mobility days’ multiplied by ‘8/7 (that is 1,14)’. In case the result is not an integer, round it up from ,5 and round it down from under ,5. (This means that e. g. in case of an 11-day mobility the minimum number of teaching hours is 13 and of a 10-day mobility it is 11 hours.) Please remember that the number of theaching hours you provide here should be the same than the one indicated in the Staff Mobility Agreement and Certificate of Teaching Activity.

INSURANCE

If you would like to share the scientific results of your mobility or a less scientific report on your experiences abroad or in Hungary and thus contribute to the promotion of the Erasmus+ ICM program at ELTE, please indicate the desired form (you may choose more than one opitons):

In-person presentation at Erasmus+ ICM promotional events, information days etc.

Lecture on the outcomes of your mobility (independent of official Erasmus+ ICM promotional events)

Academic article

Written report (with photos)

Photo report (with at least 10 pictures, a brief introduction and short descritpions to the pictures)

Video report

Blog/Vlog during the mobility period

Brief interview

Please bear in mind that your insurance coverage shall include health insurance, liability insurance and accident insurance and should be one that is accepted in the EU - i.e. valid within the Schengen Area covering at least 30 000 EUR medical expenses - and covers the entire mobility period.

Name of the insurance company

ID number of your insurance policy or insurance card

ATTACHEMENTS

Copy of valid passport

No file selected

Copy of insurance policy or insurance card

No file selected

Mobility Agreement (completed & signed by all three parties)

No file selected

DECLARATION OF PROMOTIONAL ACTIVITY

The aim of the promotional activity is to disseminate knowledge and experience gained during the Erasmus+ ICM mobility and to inform students and staff of ELTE and the broader public of the scientific cooperations and successful work that can be achieved by the aid of this program. We encourage you to share the outcome of your Erasmus+ ICM mobility on ELTE's website (or in person at an event at ELTE) in a form you find most suitable. Promotional activities are not obligatory.

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