<p> UITRUILPROGRAM VIR PERSONEELLEDE EXCHANGE PROGRAMME FOR STAFF MEMBERS 2017</p><p>1. INSTRUCTIONS 1. Complete the application form by entering the requested data into all form fields. 2. Once completed, save in PDF form. 3. Email saved PDF form with attachments (as indicated in the checklist at the end of the application form) to Lidia du Plessis at [email protected] 2. PARTNER INSTITUTION 2.1. Name of partner institution: </p><p>2.2 Please indicate if this is an Academic or Support Staff application: </p><p>3. BIOGRAPHICAL INFORMATION 3.1 Title: 3.2 Initials: 3.3 Surname: 3.4 Department: 3.5 Position:</p><p>3.6 Date of appointment at Stellenbosch University (dd/mm/yyyy): 3.7 Tel. Work: Cell nr: Email address: 3.8 Accompanied by family? Yes No Details, if accompanied:</p><p>4. DETAILS OF PROJECT/VISIT 4.1 Title or description of academic programme OR short work plan at host institution:</p><p>4.2 Name of host / associate: 4.3 Email address: 4.3 Department / Institute/ Faculty where you will be working: 4.4 Address:</p><p>4.5 Period (provide exact dates where possible): 4.6 Significance or intended outcome of project/exchange for department / faculty:</p><p>Georganiseer deur Stellenbosch University International Organised by Stellenbosch Univeresity International UITRUILPROGRAM VIR PERSONEELLEDE EXCHANGE PROGRAMME FOR STAFF MEMBERS 2017</p><p>5. CHECKLIST FOR ATTACHMENTS (5.2 may be disregarded if not applicable for support staff applications) 5.1 Letter of invitation (if not available, please include email correspondence) 5.2 Research record for the past 5 years Provide a list of any of the following information:  Articles in recognised JOURNALS  Articles in PROCEEDINGS of national and international congresses  OTHER subject related publications  PAPERS at national and international conferences  PROMOTER/CO-PROMOTER: completed and current theses and Dissertations</p><p>5.3 Confidential Recommendation from Line Manager/Chair of the Department/Director of Institute (indicating the importance of the research programme or short work plan for both institutions)</p><p>5.4 Confidential Recommendation from the Dean or Chair of Management Committee of the Institute / Centre or Vice-Rector (indicating the importance of the research programme or short work plan for both institutions)</p><p>6. SIGNATURE</p><p>I have read and understood the application procedure and will submit the completed application form in addition to the requested document as per the checklist.</p><p>Signature of applicant:</p><p>Date (dd/mm/yyyy):</p><p>Georganiseer deur Stellenbosch University International Organised by Stellenbosch Univeresity International</p>