Please fill for the form for EACH applicant of the EJN Staff Exchange programme with the information and CV of the applicant and the desired period between October 25th 2017 to December 31st 2018 (please remember EJN will cover costs for up to max. 10 consecutive days). Please indicate the sending organisation (EJN member) as well as the agreed host organisation (also EJN member). For a description and practical details of the exchange programme please refer to:
*Please note that you should contact in advance the host organisation and agree a draft work-plan for the stay before submitting your application.
DEADLINE FOR APPLICANTS: 04 DECEMBER 2017 (first-come, first-served)

* 1. Applicant's first name

* 2. Family name/s

* 3. Date of birth


* 4. Applicant's email address

* 5. Phone number (with international code, preferably mobile phone)

* 6. CV of the applicant

DOCX, DOC, JPEG, JPG, PDF, PNG file types only.
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* 9. Reference person inside the host organisation (Full name, title)

* 10. Email of the reference person inside the host organisation

* 11. Dates of the exchange (Please remember EJN will cover up to max. 10 consecutive days between 25 October 2017 and 31 December 2018)

Starting date
Ending date

* 12. Agreed areas of work during the exchange

* 13. Proposed work programme/schedule for the staff exchange (daily break-out for the days fo the exchange), agreed with the host organisation. Max 200 words