Staff Exchange application form - European Creative Hubs Network

Staff Exchange Mobility Program
Application Form

Applicant information

First Name:

Last Name:

Email

Mobile phone number:

Gender

Year of birth

Nationality

Exchange details:

Your creative hub:

Your position in the organisation:

Your organisation’s website:

Your organisation’s address:

The hub you are willing to visit:

The hosting hub website:

The hosting hub address:

Did you already check the hosting hub’s availability?
YES NO

Proposed dates:

Work Plan

Title of the exchange:

Main format of the mentoring:

Main objectives:

Program:

Expected outcomes:

Personal data disclaimer
Kindly tick the appropriate answer for the 3 questions below:
Your personal information collected for the purpose of managing the scheme and the European Creative Hubs Network project, will be used in line with data protection standards of ECHN.
ECHN will treat all personal information in accordance with EU law, including data transfers, and its own information security and privacy policy, and will not sell or disclose your details to 3rd parties for commercial reasons.

By answering the questions on the application form I agree that some of this information might be used by ECHN in the reporting process to the European Commission.
YES NO

My contact data can be shared with other participants.
I agree I don’t agree

Name

Title

Date

Signature

Staff Exchange Mobility Program Application Form

Staff Exchange Mobility Program
Application Form