1. No category

Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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General Information
This application form consists of the following main sections:
-
-
-
Context: this section asks for general information about the type of project proposal you
want to submit and about the Agency that will receive, assess and select your proposal;
Participating organisation(s): this section asks for information about the applicant
organisation and – if relevant – about any other organisation involved as partners in the
project;
Description of the project: this section asks for information about all the stages of the
project: preparation, implementation of main activities (meaning the Mobility activities) and
follow-up;
Budget: in this section you will be asked to give information about the amount of the EU
grant you request;
Check List/Data Protection Notice/Declaration of Honour: in these sections, the applicant is
made aware of important conditions linked to the submission of the grant request;
Annexes: in this section, the applicant needs to attach additional documents that are
mandatory for the completion of the application.
Submission: in this section, the applicant will be able to confirm the information provided
and to submit the form online.
For more information on how to fill in this application form, you can read the Technical Guidelines
for e-Forms.
For more information on the award criteria according to which the quality assessment of this
application will be done please refer to the Programme Guide.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Context
Programme
Erasmus+
Key Action
Learning Mobility of Individuals
Action
Mobility of Learners and Staff
Action Type
School education staff mobility
Call
2015
Round
Deadline for Submission (Brussels, Belgium Time)
4 March, 2015 12:00:00
Language used to fill in the form
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Project Identification
Project Title
If your project has a particular focus then that
should be the title (e.g. Student-Centred Teaching,
Materials Design, CLIL, etc.), otherwise simply write
‘Teacher Development (CPD)’
Project Start Date (dd-mm-yyyy)
This must be the date your European
Development Plan starts.
Enter 12 or 24 months, depending on whether your
European Development Plan spans 1 or 2 years.
Project Total Duration (Months)
Project End Date (dd-mm-yyyy)
Applicant Organisation Full Legal Name (Latin
characters)
Form Hash Code
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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National Agency of the Applicant Organisation
Identification
For further details about the available Erasmus+ National Agencies, please consult the following
page:
http://ec.europa.eu/education/erasmus-plus/national-agencies_en.htm
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Participating organisation(s)
Applicant Organisation
Role
APP - Applicant Organisation
This is the number you will be given once you
have registered on the European Commission
Participants Portal. Detail on how to do that
and generate your PIC number can be found by
clicking here.
PIC
Full legal name (National language)
Full legal name (Latin characters)
Acronym
National ID (if applicable)
Department (if applicable)
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Website
Email
Telephone 1
Telephone 2
Fax
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Profile
Type of Organisation
Just write the name of the type of school.
Is your organisation a public body?
Is your organisation a non-profit?
Total number of staff
Total number of learners
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Consortium
Are you applying on behalf of a consortium?
YES
NO
Consortium member
Role
Consortium Member
PIC
Check PIC
Full legal name (National language)
Full legal name (Latin characters)
Acronym
National ID (if applicable)
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Website
Email
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
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Telephone 1
Telephone 2
Fax
Profile
Type of Organisation
Is the organisation a public body?
Is the organisation a non-profit?
Total number of staff
Total number of learners
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Background and Experience
Please briefly present your organisation.
Be comprehensive with this section.
Does your school specialise in certain subjects e.g. science, linguistics? Say so here.
How many students and teachers are at your school?
What other activities is the school involved in?*
What experience does the school have of the project topic/subject?*
* This project needs to fit into other activities, and should also compliment your current experience in the
topic. This doesn’t mean you already have to be experts but that it is a highlighted area of importance for
good reason.
What are the activities and experience of your organisation in the areas relevant for this application?
Please give information on the key staff/persons involved in this application and on the competences
and previous experience that they will bring to the project.
-
Provide the names of the teachers/staff you want to send for this training.
Explain why you have chosen them e.g. they are very motivated…., they have a strong ability to
cascade/disseminate knowledge to their peers. The last point is important because your grant will only be
given if the project clearly benefits more than just the teachers sent. You could even go as far as to say that
the selected teachers have set a training plan in place for their return to the school so that the knowledge can
be shared comprehensively.
Have you applied for/received a grant from any European Union programme in the 12 months
preceding this application?
YES
NO
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Please indicate:
EU Programme
Year
Project Identification or
Contract Number
Applicant/Beneficiary Name
[+][-]
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Legal Representative
Role
LR – Legal Representative
Title
Gender
First Name
Family Name
Department
Position
Email
Telephone 1
If the address is different from the one of the organisation, please tick this box
□
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Telephone 2
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Contact Person
Role
CP – Contact Person
Title
Gender
First Name
Family Name
Department
Position
Email
Telephone 1
If the address is different from the one of the organisation, please tick this box
□
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Telephone 2
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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If your project includes job shadowing or teaching assignment at a partner organisation abroad, please click the
button below to add information about the partner organisation(s).
‘Lewis School of English (Lewis Teacher Training Centre)’ is a ‘course provider’, NOT a ‘partner organisation’ .See
p.59 of the Erasmus+ Programme Guide here.
Add Partner
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Partner Organisation
Role
PA - Partner Organisation
PIC
Check PIC
Full legal name (National language)
Full legal name (Latin characters)
Acronym
National ID (if applicable)
Department (if applicable)
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Website
Email
Telephone 1
Telephone 2
Fax
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Profile
Type of Organisation
Is the partner organisation a public body?
Is the partner organisation a non-profit?
Total number of staff
Total number of learners
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Background and Experience
Please briefly present the partner organisation.
As mentioned above, this is NOT us. We are a ‘course provider’.
What are the activities and experience of the organisation in the areas relevant for this application?
Please give information on the key staff/persons involved in this application and on the
competences and previous experience that they will bring to the project.
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Legal Representative
Role
LR – Legal Representative
Title
Gender
First Name
Family Name
Department
Position
Email
Telephone 1
If the address is different from the one of the organisation, please tick this box
□
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Telephone 2
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Contact Person
Role
CP – Contact Person
Title
Gender
First Name
Family Name
Department
Position
Email
Telephone 1
If the address is different from the one of the organisation, please tick this box
□
Address
Country
Region
P.O. Box
Post Code
CEDEX
City
Telephone 2
Add Partner
Remove Partner
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School Education Staff Mobility
Erasmus+
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SECTION IS VISIBLE IF NOT CONSORTIUM IS APPLYING
European Development Plan
What are the organisation's needs in terms of quality development and internationalisation? Please
identify the main areas for improvement (for example management competences, staff
competences, new teaching methods or tools, European dimension, language competences,
curriculum, the organisation of teaching and learning).
Focus on areas regarding further training and be detailed.
You must include an international dimension here at every opportunity, so consider the following areas:
global competition
the need for closer links with the world of work from your students’ social-economic standpoint
the higher education (e.g. university) opportunities you need to set your students up from an early time in their
education
NB. These points above do not cover all aspects but are meant to get you thinking about it in more detail
Describe your underlying beliefs, this year’s goal, the wider goal and what you have done so far. Be specific about
your requirements and needs.
Please outline the organisation's plans for European mobility and cooperation activities, and explain
how these activities will contribute to meeting the identified needs.
Show how your Erasmus+ activities align with your European Development Plan.
How will the outcome of the training activities at Lewis School contribute to your organizational
development? Think realistically about what your local agency will want to read here. Consider both short
and long-term development, and the trick here is to be practical.
How many people will be affected by the training? The more the better! Be specific about who and how their
learning will be passed further along and to whom. Again, be realistic and practical
A good starting point here is to say something along the lines of ‘learning from international training
specialists will build confidence in teachers as they build knowledge and further awareness. This will
permeate through the school, and most importantly therefore to its students and other stakeholde rs...[but
must say more…]
Please explain how your organisation will integrate the competences and experiences acquired by
staff participating in the project, into its strategic development in the future?
-
Explain how you will share the learning from the course with specific reference to particular activities.
For example, will teachers who participate in the course then share the experience to their colleagues
through formal means such as training sessions? Yes needs to be the answer. Explain therefore how.
-
Give a number of how many people will be affected by the outcomes of the course at Lewis. Consider
the opportunity to share the knowledge gained with other schools and other teachers also. This
philanthropic approach will benefit your grant application a lot. However, you will need to follow
through e.g. a conference with local schools to share the experience.
-
Again, mention how the course will benefit long-term plans at your school.
What impact with the training have on pupils, teachers, other staff and the school overall? IMPORTANT.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Will your organisation use eTwinning in connection with your mobility project? If so, please describe
how.
The eTwinning website can be accessed through the following hyperlink: www.etwinning.net
eTwinning isn’t compulsory, but it can significantly help your application. Have you taken part in an eTwinning
project in the past, or will you in the future? If yes, say so here with some minor detail.
See pages 221-222in the Erasmus+ Programme Guide for more info.
If you have no plan to eTwin now, then you could just register on the eTwinning portal so that you can say in this
application that you have registered and intend to eTwin in the future…as long as that is true! Follow the link above
to register.
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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SECTION VISIBLE IF CONSORTIUM IS APPLYING
European Development Plan
What are the needs of the consortium in terms of quality development and internationalisation?
Please specify for each consortium member, identifying the main areas for improvement (for
example management competences, staff competences, new teaching methods or tools, European
dimension, language competences, curriculum, the organisation of teaching and learning).
Please outline the consortium’s plans for European mobility and cooperation activities, and explain
how these activities will contribute to meeting the identified needs of each consortium member.
Please explain how the competences and experiences acquired by staff participating in the project
will be integrated into the strategic development of each consortium member and of the consortium
as
a
whole?
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Will your consortium use eTwinning in connection with your mobility project? If so, please describe
how.
The eTwinning website can be accessed through the following hyperlink: www.etwinning.net
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Description of the Project
Why do you want to carry out this project? What are its objectives?
-
State the aims and objectives of the project.
Outline the training undertaken and how this fits in with the school’s overall European Development Plan
goals for the next one or two years.
NB. Be clear, be practical, and reach a conclusion that is desirable. The reader must see the logic.
How did you choose your project partners? What experiences and competences will they bring to the
project? Please also describe how the project meets the needs and objectives of your partners.
Show evidence of your research into your chosen field. Show evidence as to why Lewis School of English is the right
provider:
Lewis tailors training courses to meet the needs of individuals and their institutions. We have worked within
schools abroad, across the EU, for years now. The Erasmus+ mission is one the provider has always lived by
Lewis School of English has a designated teacher training centred where the training would take place.
Lewis School delivers multiple in-service training courses, both in Southampton and in-country, as well as an
initial certification course (Trinity CertTESOL)
The international dimension has always been considered by Lewis. They have put schools in touch, built an
online global community that shares best practice teaching methods, and worked with teaching associations
around the world.
The school is accredited by the BC and is a member of English UK, and was recently rewarded the heighted
possible marks in the ISI inspection.
What are the most relevant topics addressed by your project?
[+][-]
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Erasmus+
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Participants' Profile
Please describe for each planned activity the background and needs of the participants involved and
how these participants have been or will be selected
-
How will the course participants’ career progression and professional development (CPD) be enriched by this
training?
-
Which selection criteria are used when deciding which teacher/staff member to send? E.g. Motivation,
academic achievement, goals and the intention to share their experience upon return.
E.g. reward for good teaching/ this teacher hasn’t had much opportunity to develop in the past/ they have a
status whereby they can share their experience effectively with other teachers/ etc…
NB. It is highly recommended that you point out that participants are chosen by a panel rather than a single
decision-maker, and that there is a written record of the process.
.
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Learning Outcomes
Which competences (i.e. knowledge, skills and attitudes/behaviours) are to be acquired/improved by
participants in each planned activity of your project?
Keep this simply. What are your KEY OBJECTIVES? DESIRED OUTCOMES?
Give a shortlist of the knowledge, skills, and attitudes you will acquire:
-
Knowledge (e.g. more creative and student-centred methods), and how this will benefit school, students and
stakeholders?
Skills (e.g. ability to use mobile phones in the classroom for learning benefits), and how this will benefit…?
Attitudes/behaviours (e.g. Raised cultural awareness for the benefit of creating global citizens in students),
and then how these attitudes and behaviours will be affected by this?
The Erasmus+ Programme promotes the use of instruments/certificates like Europass, ECVET and
Youthpass to validate the competences acquired by the participants during their experiences abroad.
Will your project make use of such European instruments/certificates? If so, which ones?
[+][-]
Are you planning to use any national instrument/certificate? If so, which one?
Lewis School approves of the Europass certificate.
How will you use the European/national instrument(s)/certificate(s) selected?
-
Describe how this will be an excellent way to support the development of your teachers because it will enrich,
develop and ‘internationalise their portfolio’. Remember, always consider the international dimension throughout
this application.
The document will aid participation in future career development as it builds connections with colleagues in other
countries and presents opportunities for future exchanges and job shadowing.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Preparation
Please describe for each planned activity what will be done in preparation, by your organisation and,
if relevant, by your partners and/or consortium members before the main activities take place.
Practical Arrangements
How will the practical and logistic matters of each planned activity are addressed (e.g. travel,
accommodation, insurance, safety and protection of participants, visa, social security, mentoring and
support, preparatory meetings with partners etc.)?
-
-
-
-
-
Accommodation
Note here that Lewis offer homestay accommodation all year around. Note too, that we have a host of
families experienced in housing teachers specifically; therefore they appreciate the challenges foreign
teachers can experience when attending a course abroad, and therefore create a conducive home
environment for them. These are the benefits of having a designated teacher training centre.
We strongly suggest homestay as the cultural experience will support your application as it is part of the
‘international dimension tick box’. Mention your intent for homestay because of the international
knowledge it will gain for each individual.
During the summer courses Lewis provides a range of accommodation options e.g. residential
accommodation e.g. private studios
Travel & Visa
Advice on travel is given. We provide cost effective solutions and a meet and greet service if preferred. We
can include taxi transfers in the service, however this is more expensive.
Visa letters can be issues by Lewis. Lewis has a dedicated welfare team to support participants throughout
their stay.
Other aspects
We provide info re living costs, and other aspects of UK life before arrival e.g. approximate cost of living per
day, health and safety aspects e.g. local hospital info, emergency numbers, etc. We also offer a pre-arrival
Skype call to answer any last minute matters. Furthermore, we have an online platform where teachers ‘emeet’ each other and effectively help each other in their pre-arrival preparations. This also socializes the
group and effectively breaks the ice.
How will you address quality and management issues (e.g. setting up of agreements with partners,
learning agreements with participants, etc.)?
Referring back to your development plan, show that you designed a project management system; within that
system make sure it shows a learner agreement covering needs analysis, desired outcomes, and evaluation and
assessment methods. Indicate a clear time-scale for each step of your project.
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Erasmus+
Preparation of Participants
Which kind of preparation will be offered to participants (e.g. task-related, intercultural, linguistic, riskprevention etc.)? Who will provide such preparatory activities?
Indicate that linguistic and intercultural preparation can be provided by both the applying organisation/ sending school (i.e.
you), and by Lewis School of English. Keep it simple and common sense, e.g. a workshop for the trainees. However, have
multiple elements.
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Main Activities
Please outline chronologically the main activities you plan to organise. If relevant, please describe the
role of each project partner and/or consortium members in the activities.
Be detailed here. Outline the course aims and objectives, AND any pre and post course activities (main
ones) e.g. pre-course workshops to do some research into topic areas, INSET sessions at your school to
other teachers post-course
Full course descriptions for all Lewis courses can be found on Lewis EU Courses. Once on the page, click on
your course for full descriptions.
NB. If you plan to organise more than one activity during the period of your
Development Plan, then list them here.
If applicable, how do you intend to cooperate and communicate with your project partners and/or
consortium members and other relevant stakeholders?
List methods of communication e.g. Skype, online forums, newsletters, email, letters, etc. We also offer an online
platform and every participant will be registered before they arrive. Please mention that Lewis will send weekly
email during the month prior to arrival to assist preparation. Each will focus on various areas e.g. welfare, course
reading, etc.
How will the participants be monitored during their training placement? Who will monitor their work
programme and progress?
List the types of monitoring and evaluation which will be used in order to best assess the identified learner
outcomes e.g. end-of-course evaluation questionnaires, individual reports from course tutors, etc.
Please state that Lewis always provide individual reports to each teachers at the end of the course, this
highlights their strengths, knowledge, attitude, etc., and most importantly suggested next steps and action
plans considering their context, which we will have learned about by the end of the course.
Please state that we also offer 1:1 tutor feedback sessions, optional for participants. These are to discuss course
expectations, performance, etc.
If applicable, please explain the need for accompanying persons.
For either linguistic or physical reasons – please provide full details
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Activities' Details
Please enter the different mobility activities you intend to implement in your project.
Flow
No.
Country
of Origin
Country of
Destination
Distance Band
Total
Duration
Excluding
Travel
Travel
Days
Total Duration
Including Travel
No. of
Participants
(days)
(days)
Participants
with Special
Needs (out of
total number
of
Participants)
1
…
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Accompanying
Persons (out of
total number of
Participants)
No. of Non-Teaching
Staff (out of total
number of
Participants)
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Summary of Activities and Participants
Activity Type
No. of Activities
Total
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No. of Participants
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Follow-up
Please describe what will happen after the end of your main activities.
Impact
What is the expected impact on the participants, participating organisation(s) and target groups?
-
Ability to use…/ Increased awareness of…/ more insight into…/ knowledge of…/ greater understanding of…
-
Try and quantify these effects and you must include how it may affect staff members back at your school and
students
-
Describe the network you intend to build, materials produced, both physical and potential, how more pupils
will be enjoying the benefits of teaching and learning, and the improved reputation of the school.
-
Will you be prepared to share the learning with other local schools e.g. a weekend conference inviting English
teachers from the region? This would be an excellent mission that will support your grant application.
Dissemination of projects' results
Which activities will you carry out in order to share the results of your project outside your
organisation/consortium and partners? What will be the target groups of your dissemination
activities?
Please note that all Lewis teacher training courses include post-course activities that lead up to ‘experimental
lessons’. Participants are encouraged to apply new ideas back in their classrooms, with the course provider’s
support (which can be a good motivator). Outline the benefits of this and how it can benefit other teachers, as
well as the students themselves! Note any planned post-course training sessions you have with participants –
cascading best practice is important.
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Evaluation
Which activities will you carry out in order to assess whether, and to what extent, your project has
reached its objectives and results?
Write a clear description of the things you will do to see if your project has reached its goals: for
example, participant feedback questionnaires, more effective classroom teaching, improved results,
greater student satisfaction, parent feedback, etc.
We offer the opportunity to catch up after a period of time has passed to discuss our expectations of
them versus yours. Together we can then decide what has and has not been achieved. It may be
worth mentioning this here.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Budget
For further information please consult the Programme Guide for the overview of funding rules. Please note that all amounts must be expressed in Euros.
Travel
Activity No.
Activity
Type
Flow No.
Country of Origin
Country of Destination
Distance
Band
No. of Participants
Travel Grant per
Participant
Total Travel
Grant
Requested
[A]
[B]
[C = A * B]
Total
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[SUM]
Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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Individual Support
Activity
No.
Activity Type
Flow
No.
Country of
Destination
Total Duration
(days)
No. of
Participants
(Excluding
Accompanying
Persons)
Grant per
Participant
No. of
Accompanying
Persons
Grant per
Accompanying
Person
Total Grant
Requested
[B]
[C]
[D]
[E = (A * B) + (C * D)]
[A]
Total
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Organisational Support
No. of Participants (excluding accompanying persons)
Total Grant Requested
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Course Fees
Activity
No.
Activity Type
Duration (days)
No. of Participants
Grant per
Participant/Day
Total Grant Requested
[C]
[D = A * B * C]
[B]
[A]
Total
[+][-]
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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Special Needs' Support
Activity
No.
Activity Type
No. of Participants With
Special Needs
Description of Costs
Total Grant Requested
Total
[+][-]
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Exceptional Costs
Activity
No.
Activity Type
No. of Participants
Description of Costs
Total Grant requested
Total
[+][-]
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School Education Staff Mobility
Erasmus+
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Please provide any further comments you may have concerning the above entered budget.
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Project summary
Please provide a short summary of your project. Please recall that this section [or part of it] may be
used by the European Commission, Executive Agency or National Agencies in their publications. It will
also feed the Erasmus+ dissemination platform.
Be concise and clear and mention at least the following elements: context/background of project;
objectives of your project; number and profile of participants; description of activities; methodology
to be used in carrying out the project; a short description of the results and impact envisaged and
finally the potential longer term benefits.
VERY IMPORTANT SECTION. POINTS WILL BE AWARDED BASED ON WHAT YOU WRITE AND HOW YOU
WRITE IT/
.
Here, you should mention without being repetitive::
-
Background
Objectives
The course participants
What the activities will be
What the results and impact of the training course in the short and longer term will be
Goals with the European dimension, big and small
How the project provides strategic development, locally, nationally and internationally
Be concise and extremely practical.
Please provide a translation in English.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Summary of participating organisations
Name of the Organisation
Country of the Organisation
Type of Organisation
Total number of participating organisations
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Budget Summary
The sum of previous sections representing the total grant requested for this application.
Activity
No.
Activity Type
Travel
Individual
Support
Course
fees
Special Needs
Support
Exceptional
Costs
Total
Total
Organisational Support
Project Total Grant
Grant Calculated
Grant Requested
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Checklist
Before submitting online your application form to the National Agency, please make sure that it
fulfils the eligibility criteria listed in the Programme Guide and check that:
 you have used the official Key-Action 1 application form.
 all relevant fields in the application form have been completed.

you have chosen the correct National Agency of the country in which your organisation is
established.
 the application form has been completed using one of the official languages of the Erasmus+
Programme Countries.
 you have annexed all the relevant documents:
 the Declaration of Honour signed by the legal representative mentioned in the application.
 the mandates of each partner to the applicant signed by both parties.
 all participating organisations have uploaded the documents to give proof of their legal status in
the participants’ portal (for more details, see the section "Selection Criteria" in Part C of the
Programme Guide).
 for grants exceeding 60 000 EUR, you have uploaded the documents to give proof of your
financial capacity in the participants’ portal (for more details, see the section "Selection Criteria"
in Part C of the Programme Guide). Not applicable in the case of public bodies or international
organisations.
 you are complying with the deadline published in the Programme Guide.
 you have saved or printed the copy of the completed form for yourself.
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Data Protection Notice
PROTECTION OF PERSONAL DATA
The application form will be processed electronically. All personal data (such as names, addresses,
CVs, etc.) will be processed in pursuant to Regulation (EC) No 45/2001 on the protection of
individuals with regard to the processing of personal data by the Community institutions and bodies
and on the free movement of such data. Any personal data requested will only be used for the
intended purpose, i.e.:
- In the case of grant application forms: the evaluation of your application in accordance with the
specifications of the call for proposals,
- In the case of application for accreditation forms: the evaluation of your application in accordance
with the specifications of the call for proposals,
- In the case of report forms: statistical and financial (if applicable) follow-up of the projects.
For the exact description of the collected personal data, the purpose of the collection and the
description of the processing, please refer to the Specific Privacy Statement accompanying this form.
You are entitled to obtain access to your personal data on request and to rectify any such data that is
inaccurate or incomplete. If you have any queries concerning the processing of your personal data,
you may address them to your National Agency. You have the right of recourse at any time to your
national supervising body for data protection or the European Data Protection Supervisor for matters
relating to the processing of your personal data.
You are informed that for the purposes of safeguarding the financial interest of the Communities,
your personal data may be transferred to internal audit services, to the European Court of Auditors,
to the Financial Irregularities Panel and/or to the European Anti-Fraud Office (OLAF).
http://www.edps.europa.eu/
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Declaration of Honour
To be signed by the person legally authorised to enter into legally binding commitments on behalf of
the applicant organisation. Once signed it must be scanned and annexed to this application form.
I, the undersigned, certify that the information contained in this application form is correct to the
best of my knowledge. I put forward a request of an Erasmus+ grant as set out in section BUDGET of
this application form.
Declare that:
- All information contained in this application, is correct to the best of my knowledge.
- In the case of projects in the field of youth, the participants involved in the activities fall in the age
limits defined by the Programme.
- The organisation I represent has the adequate legal capacity to participate in the call for proposals.
EITHER
The organisation I represent has financial and operational capacity to complete the proposed action
or work programme
OR
The organisation I represent is considered to be a "public body" in the terms defined within the Call
and can provide proof, if requested of this status, namely:
It provides learning opportunities and
- Either (a) at least 50% of its annual revenues over the last two years have been received from public
sources;
- Or (b) it is controlled by public bodies or their representatives
I am authorised by my organisation to sign Community grant agreements on its behalf.
Certify that (in case the grant requested exceeds 60 000€):
The organisation I represent:
- is not bankrupt, being wound up, or having its affairs administered by the courts, has not entered
into an arrangement with creditors, has not suspended business activities, is not the subject of
proceedings concerning those matters, nor is it in any analogous situation arising from a similar
procedure provided for in national legislation or regulations;
- has not been convicted of an offence concerning its professional conduct by a judgment which has
the force of ‘res judicata’;
- has not been guilty of grave professional misconduct proven by any means which the National
Agency can justify;
- has fulfilled its obligations relating to the payment of social security contributions or the payment of
taxes in accordance with the legal provisions of the country in which it is established or those of the
country
where
the
grant
agreement
is
to
be
performed;
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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- has not been the subject of a judgment which has the force of ‘res judicata’ for fraud, corruption,
involvement in a criminal organisation or any other illegal activity detrimental to the Communities'
financial interests;
- it is not currently subject to an administrative penalty referred to in Article 109(1) of the Financial
regulations (Council Regulation 966/2012).
Acknowledge that:
The organisation I represent will not be awarded a grant if it finds itself, at the time of the grant
award procedure, in contradiction with any of the statements certified above, or in the following
situations:
- subject to a conflict of interest (for family, personal or political reason or through national,
economic or any other interest shared with an organisation or an individual directly or indirectly
involved in the grant award procedure);
- guilty of misrepresentation in supplying the information required by the National Agency as a
condition of participation in the grant award procedure or has failed to supply this information.
In the event of this application being approved, the National Agency has the right to publish the
name and address of this organisation, the subject of the grant and the amount awarded and the
rate of funding.
Commit:
- my organisation and the other partner organisations herein, to take part upon request in
dissemination and exploitation activities conducted by National Agencies, the Executive Agency
and/or the European Commission, where the participation of individual participants may also be
required.
I acknowledge that administrative and financial penalties may be imposed on the organisation I
represent if it is guilty of misrepresentation or is found to have seriously failed to meet its
contractual obligations under a previous contract or grant award procedure.
Place:
Date (dd-mm-yyyy):
Name of the applicant organisation:
Name of legal representative:
Signature:
National ID number of the signing person (if requested by the National Agency):
Stamp of the applicant organisation (if applicable):
Print Declaration of Honour
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KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
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Annexes
Please note that all documents mentioned in section "Checklist" need to be attached here before you
submit your application online.
File Name
File Size (kB)
Filename1.docx
100
REMOVE
Filename2.xlsx
200
REMOVE
ADD
ADD
ADD
Total Size
300
[MAXIMUM NUMBER OF ATTACHMENT: 10]
[MAXIMUM TOTAL SIZE OF ATTACHMENTS: 10 MB]
[ALLOWED FILE TYPES: PDF,DOC,DOCX,XLS,XLSX,JPG,TXT,ODT,ODS]
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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Submission
Before submitting the form electronically, please validate it. Please note that only the final version of
your form should be submitted electronically.
Data Validation
Validation of compulsory fields and rules
Validate
Standard Submission Procedure
Online submission (requires internet connection)
Submit Online
Alternative Submission Procedure
If you cannot submit your form online you can still do it by sending an email to your National Agency
within the 2 hours following the official deadline. The email must contain the complete electronic
form and any file attachments you wish to send. You must also attach a snapshot of section
"Submission Summary" indicating that this electronic form could not be submitted online. Your
National Agency will analyse your situation and provide you with further instructions.
Submission Summary
This table provides additional information (log) of all form online submission attempts, particularly
useful for the National Agencies in case of multiple form submissions.
Number
Time
Form Hash Code
Submitted
Description
1
2015-03-01 17:51:23
(Brussels, Belgium
Time)
0000000000000000
Yes
Your
submission
was
successful.
Submission
ID: 1000785
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Application Form – Call: 2015
KA1 - Learning Mobility of Individuals
School Education Staff Mobility
Erasmus+
Form version: 0.1 Adobe Reader Version: 10.104
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Local Time cannot be considered authoritative and cannot be used for claiming that the form has
been submitted in time.
Form Printing
Print the entire form
Print Form
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