Application Form
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First name *
Surname *
Title (Ms. Mr. Dr. Prof. or other) *
Home University (Erasmus code) *
Date of birth *
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DD
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Mobile phone number *
Position & University Unit *
Brief job description, main  responsibilities, tasks  / research & teaching area *
Describe your motivation to participate in EPiC *
 I will deliver a video or presentation of the university
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I will deliver lectures (8 hours of lectures under STA Staff Mobility for Teaching)
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if yes please provide title of lectures
 One of our sessions is called 'Brainstorm session -  knowledge sharing’. During the meeting we would like to know good practices at your university. Please choose all of the topics you are ready to discuss sharing the experience of your home institution on following topics: *
Required
Is there a project/activity in your institution that you would find interesting and worth sharing during the session? Please present short description below *
I would like to participate in the following activities: *
Required
Would you like to visit particular unit or meet with a specific person at the Opole University of Technology and why? *
Planned arrival date to Opole: *
MM
/
DD
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I am allergic to ...
I am ...
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