Please read this form carefully and, upon completion, submit by 20 January 2020.

Please note that by submitting this document you commit to host a Fulbright grantee on conditions specified below. Fulbright Commission will sign contracts with the finalists of the competition based on the stipulations of this Request Form and availability of grantees with requested skills.

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* 1. Contact information regarding this form

ETA AND COURSES PREFERENCE

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* 2. Why do you apply for a Fulbright English Teaching Assistant?

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* 3. Preferred subject fields

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* 4. Desired activities of the Fulbright ETA

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* 5. Requested independence level of the ETA

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* 6. Teaching hours per week
The acceptable workload for the Fulbright ETA is up to 14 teaching hours per week. One teaching hour is 45 min.

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* 7. Office hours per week (one office hour is 45 min.)

CONTACT INFORMATION

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* 8. Appointed faculty associate (Mentor) assisting the Fulbright ETA with professional and personal questions

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* 9. Department head

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* 10. Administrative official formally responsible for the Fulbright ETA

HOUSING

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* 11. Indicate what kind of housing arrangements can be provided (please select all that apply)

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* 12. Please estimate montly cost of the housing (PLN per month, including all utilities and bills). Cost of the housing will be covered by your institution

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* 13. Additional comments regarding the housing arrangements

OTHER FORMS OF SUPPORT

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* 14. Administrative support:

  yes no
Shared office space
Free of charge Internet access
Use of office computer facilities
Copier/printer for class materials

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* 15. Other forms of support:

  yes no
Free of charge Polish language course
Provision of a monthly public transport pass
Participation of the ETA in events organized by the host institution (conferences, seminars, meetings)
Free of charge participation of the ETA in events organized for international students
Other forms of support provided to the ETA

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* 16. Additional comments

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* 17. Please indicate dates of Academic Terms and Holidays, and important public events at your Institution planned for 2020/2021

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* 18. All information provided in this request form have been authorized by

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* 19. Zgoda na przetwarzanie danych osobowych-obowiązek informacyjny

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