Creativehubs | staff exchange 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? * Required

Yes

Mentor at the hosting hub: *

Mentor's contact: *

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. * Required

Yes

My contact data can be shared with other participants. * Required

I agree

I don't agree

Name: *

Title: *

Date: *

Signature: *

staff exchange application form

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