Incoming mobility

Nominated participant

Last name *

First name *

Date of birth *

E-mail *

Gender *

M
F

Home University *

Specify *

Exchange programme *

Specify *

Does the nominee belong to one of the following categories of participants with disadvantaged backgrounds/fewer opportunities?

Cultural differences, Disability, Economic obstacles, Educational difficulties, Geographical obstacles, Health problems, Refugees, Social obstacles, Barriers linked to discrimination

No
Yes

Please choose the category applying *

Type of participant *

Academic field (if applicable)

Department/Faculty/Centre *

Specify *

Mobility type

Summer/Winter School title

No label *

Exchange period

Exchange period from *

Exchange Period to *

Notes

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