Trainee	Last name(s)	First name(s)	Date of birth	Nationality	Sex [M/F]	Study cycle	Field of education	
								
Sending Institution	Name	Faculty/ Department	Erasmus code  (if applicable)	Address	Country	Contact person name; email; phone	
	Universidad de León 		E LEON01	Avda, Facultad, 25. 24071 León	Spain	Laura Bayón Sánchez
erasmusplus@fgulem.es
+34 987 293 356	
Receiving Organisation/Enterprise	Name	Department	Address; website	Country	Size	Contact person name; position; e-mail; phone	Mentor name; position;
e-mail; phone	
					☐ < 250 employees
☐ > 250 employees			
						Supervisor  at the Receiving Organisation3	

	
	Table A - Traineeship Programme at the Receiving Organisation/Enterprise	
Planned period of the mobility: from  ……. to …….	
Traineeship title: …
	Number of working hours per week: …	
Detailed programme of the traineeship:

Knowledge, skills and competences to be acquired by the end of the traineeship (expected Learning Outcomes):

Monitoring plan:

Evaluation plan:

									

Accident insurance for the trainee
The Sending Institution will provide an accident insurance to the trainee (if not provided by the Receiving Organisation/Enterprise):                                                 Yes ☒ No ☐  
	
The accident insurance covers:  
- accidents during travels made for work purposes:     Yes ☒  No ☐    
- accidents on the way to work and back from work:   Yes ☒  No ☐	

The Sending Institution will provide a liability insurance to the trainee (if not provided by the Receiving Organisation/Enterprise):  Yes ☒  No ☐	

	

Table C - Receiving Organisation/Enterprise

The Receiving Organisation/Enterprise will provide financial support to the trainee for the traineeship:  Yes ☐ No ☐             	
If yes, amount (EUR/month): ………..

The Receiving Organisation/Enterprise will provide a contribution in kind to the trainee for the traineeship: Yes ☐ No ☐  
If yes, please specify: ….