Erasmus+ Outgoing Staff Participation/Waiver Form

PERSONAL INFORMATION

ADVERTISEMENT NUMBER AND NAME*

Turkish National Identity Number / Foreign National Identity Number*

NAME*

SURNAME*

TYPE OF MOBILITY*
—Lütfen bir seçenek seçin—KA131 STA (Intra-European Teaching Mobility)KA131 STT (Intra-European Training Mobility)KA171 STA (Non-European Teaching Mobility)KA171 STT (Non-European Training Mobility)

MOBILITY PARTICIPATION STATUS*
—Lütfen bir seçenek seçin—I declare that I will participate.I waive my right (I will not participate)

ESTIMATED MOBILITY START DATE*

ESTIMATED MOBILITY END DATE*

TITLE*
—Lütfen bir seçenek seçin—Research AssistantResearch Assistant DoctorLecturer, M.A.Lecturer DoctorAssistant ProfessorAssociate professorAssociate ProfessorProfessorProfessor DoctorAdministrative Staff

DATE OF BIRTH*

BIRTHPLACE*

UNIT (INSTITUTE/FACULTY/VOCATIONAL SCHOOL/HIGHER EDUCATION INSTITUTION)*

SECTION*

PHONE NUMBER*

EMAIL ADDRESS*

ADDRESS*

II. EMERGENCY CONTACT PERSON INFORMATION

NAME SURNAME*

DEGREE OF CLOSENESS*

PHONE NUMBER*

EMAIL ADDRESS*

ADDRESS*

III. DECLARATION*

By indicating my intention to participate in the mobility program, I declare that I will comply with the relevant legislation and regulations.

I declare that if I withdraw, I will not participate in the Erasmus+ Staff Mobility program to which I have been awarded.

Based on the aforementioned points, I acknowledge and declare that the announced placement result is not binding on the SCU Erasmus+ Institutional Coordination Office, and that my ability to benefit from the mobility program depends on the budget of the SCU Erasmus+ Coordination Office.

My data within the scope of the Law No. 6698 on the Protection of Personal Data I consent to the processing of my personal data as described in the Explicit Consent Form.

*Participants being selected to go under the Erasmus+ Staff Mobility Program does not guarantee that they will benefit from this mobility activity. Students who are selected and announced on the main/reserve list will only be able to benefit from this activity in accordance with the budget that the Turkish National Agency will provide to the Sivas Cumhuriyet University International Relations Office Erasmus+ Institutional Coordination Unit.

SIGNATURE

Security Verification