Erasmus+ Staff Mobility - TRAINING application 2023-2024

Your personal details

Last name *

First name *

Mr/Ms/Mx *

Nationality *

Date of birth *

Phone number 1 *

Phone number 2

Email address 1 *

Email address 2

Employment information

Employee number *

Job title *

Faculty or Service Unit *

Institute / Department *

Seniority *

Staff category *

Is this your first Erasmus+ training
assignment in 2023/2024? *

Contact details receiving institution / organisation

Name receiving institution / organisation *

Does the training period take place at a Higher
Education Institution? *

Erasmus code receiving institution *

City receiving institution / organisation *

Country receiving institution/organisation *

Name contact person *

Email address contact person *

Phone number contact person *

Details Erasmus+ training period

Start date - excluding travel *

End date - excluding travel *

Additional day for travel needed directly BEFORE
the first day of the teaching assignment *

Yes

Additional day for travel needed directly AFTER
the last day of the teaching assignment *

Yes

Do you plan on travelling in a sustainable way? *

Yes

In case you travel in a sustainable way, you are eligible for a 'Green Travel Top Up' on your regular travel allowance.
Your individual support will be calculated automatically.

Green travel consist of travelling with (more) sustainable means of transport to your destination.
This includes travel by train, bus or carpooling. For more information, visit the Erasmus+ for Training webpage.

Type of training *

Main working language *

Is this a training in pedagogical or
curriculum design skills? *

Upload the Mobility Agreement for Training

Mobility Agreement for Training *

Print the form

Print the form by pressing CTRL + P.

Signature and declaration applicant

The undersigned declares that he/she has read and understood the conditions of the Erasmus+
grant for Training 2023-2024 and that the information provided in this form is accurate. The
responsibility for providing a complete and signed application form lies with the undersigned.

Date

Signature (printed form)

Signature and declaration budget holder

The undersigned, budget holder of the SAP number (LUMC: kostenplaats and project code), verifies
that the training period has been authorised. Upon completion of the training period, the budget
holder will be requested to send an invoice for the Erasmus grant to the Scholarships Team. After
payment of the grant, the applicant can request the reimbursement of the grant via Self Service
(LUMC: via Albinusnet).

First name

Last name

Job title

E-mail address

SAP number (LUMC: kostenplaats and project
code)

Date *

Signature

Deadline

Send a scanned copy (in 1 PDF) of the complete and signed application form to
outbound@sea.leidenuniv.nl at least 1 month before the start of your Erasmus+
training period.

* = Input is required