Application: Erasmus+ Internatioanl Credit Mobility Lecturer Exchange Scholarship @ Karlstad University, Sweden

Full Name*

PrefixFirst NameMiddle NameLast Name

Relationship*

E-mail*

Phone Number*

Country codePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of Referee*

PrefixFirst NameMiddle NameLast Name

Title

Faculty / Office

E-mail

Phone number

Reference letter*

Upload a File

Please upload reference letter

Approval letter form your supervisor (the supervisor allow you to travel to KAU and participate in Erasmus)*

Upload a File

Please upload approve letter

D1: Any disabilities and/or medical condition that RSU CIEL should be aware of?

YesNo

If "Yes" (D1), please explain

D2: Have you ever been convicted of a criminal crime offense?

YesNo

If "Yes" (D2), please explain

3: Do you foresee any other difficulty that may affect the completion of your exchange period?

YesNo

If "Yes" (D3), please explain

CHECKLIST Have you uploaded the scanned of the following documents;

: : scan of Reference letter from Personnel Office

: : scan of Reference letter from supervisor

: : scan of Approval letter from supervisor

*This application will not be processed unless it is complete and is accompanied by the above-listed documents.

APPLICANT'S DECLARATION

By submitting this online Exchange application form, I certify that the statement made by me are true, complete, and correct to the best of my knowledge. I fully understand if I am to join the program, I agree to;

1. follow the course of study and abide by the rules of Rangsit University and the law of Thailand;

2. act in such a manner that I will not bring disrepute to myself, Rangsit University, host institution or my country of citizenship during the Exchange program;

3. abide by the rules and regulations governing my visa;

4. release information contained in this application form to relevant authorities and for RSU VIE exchange book publication;

5. responsible for any expenses that shall incur apart from Erasmus+ International Credit Mobility Scholarship during my exchange period at Karlstad University;

6. obtain full international travel and health insurance prior to the departure to Thailand;

7. the use of photographs of myself taken by Office of International Admissions and Services, Rangsit University - the likely uses include promotional materials, brochures, displays, expos, posters, cards, newspaper article, website, communication with educational agents and advertising.

8. the terms and agreements as per the Memorandum of understanding established in regard to exchange activity between the host institution and Rangsit University

Date and time of submission

MonthDayYearHourMinutesAM/PM Option

	Very good	Good	Fair	Poor
Speaking
Listening
Reading
Writing

Erasmus+ Internatioanl Credit Mobility Lecturer exchange Scholarship @ Karlstad University, Sweden

Section A: Applicant details

Section B: Lecture details

Section C: Emergency contact

Section D: Reference

Section E: Medical and further information