Working Programme

for the study stay in the framework of the agreement between Charles University
and the

Family name and first name:
Scientific degree and position held:

Date of birth:
Home address:
Tel:

University, Faculty, Institute or Department:
Address:
Tel:

Institute(s) and person(s) to be visited:
Indication of activity to be carried abroad:

Length of stay:
Proposed date of journey:
Knowledge of languages:

...............................................
Signature of the Vice Dean
for the Internationl relations
...............................................
Signature of the applicant

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