Application for Erasmus Incoming Staff for Teaching (STA)

Attention!

• Please take care of the correct spelling of your email adress!
• Because of technical reasons, the online form only accepts "german" letters. Please do not give in chinese, cyrillic or letters who are not used in the german system. Letters with accents like é, â oder ñ are unfortunately not accepted, too. (Then just write down the letter without the accent)
• Even the letters Ä, Ö, Ü can not be sent, too. Please write then ae, oe or ue, like "Universitaet".

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----- Applicant's data -----
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Mrs./Ms./Mr.:	Ms. Mr.
Titel (Dr., Prof.):
Last name (Family name)*:
First name*:
Date of birth (dd.mm.yyyy)*:
Citizenship*:
E-Mail*:
Street and House number*:
Postleitzahl/Zip-Code*:
City/Place*:
Country*:
Telephone number including country code (e.g. +33 12344567890)*:
Sending University /Home University*:
Sending country*:
Department at Home University*:
Your level of teaching:	Bachelor Master PhD
Work experience:	Junior (0-10 years) Intermediate (11-20 years) Senior (more than 20 years)
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----- Planned stay at Trier University -----
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Academic year of this Erasmus mobility*:
Is it your first mobility within the Erasmus programme?:	Yes No
Host department*:
Contact Person / Departmental Coordinator at the host department*:
Teaching Language at the host department*:
Subject taught at host department*:
Field of education (link to code list see below)*:
First day of activity at Trier University (dd.mm.yy)*:
Last day of activity at Trier University (dd.mm.yy)*:
Number of days of your Erasmus mobility (excluding travel days)*:
Travel days:	0 days 1 day 2 days
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-------- FINANCIAL SUPPORT ---------
If no bank account in Germany is available, the financial support will be paid out via CASH CHEQUE during your stay at Trier University!
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I ask for transfer of the financial support to the following bank account in Germany:	No Yes
Name oft the owner of the bank account:
Name of the bank:
IBAN:
BIC:
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Do you apply for special needs support grant?:	No YES
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Comments:
After sendung your data, you will receive an confirmation email. If you do NOT receive it, please check your email spam folder. If even there is no email from us, it could be that your email adress was invalid. In this case you should send your data again!
By sending this registration form I CONFIRM my application.*:
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