Federal State Autonomous Educational Institution of Higher Education

«National Research Tomsk State University»

To Rector TSU

E. Galazhinskiy

_______________________________

Last name

________________________________________

First name, Middle name

________________________________________

position, department/division

________________________________________

phone, e - mail

Application

I hereby request a permission to go on a business trip to _______________________________

________________________________________________________________________________(country, city/town, receiving organization) to participate in(topic/aim of the trip___________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________ in order to carry out academic mobility program of TSU.

Trip activity type(underline: research/educational/organizational and methodological)

Research area (scientific/educational) In accordance with sub-s 2.6 of the «Regulations»

Trip duration (departure from/arrival to Tomsk):___ _____20___ /___ _______20___

Activity duration: from __ ______20___ to __ _______20___

Estimate of costs:

№	Expense item	Amount
1.	Travel (RUB)	Indicate the itinerary
2.	Accommodation (RUB) Current maximum amount can be found at: http://www.consultant.ru/cons/cgi/online.cgi?req=doc&base=LAW&n=210488&rnd=244973.2898616508#0	Number of days, price per night and total amount
3.	Visa fee (RUB)
4.	Health Insurance (RUB)
5.	Daily allowance (RUB) Per diem rates can be found at (in Russia 100 RUB): http://www.consultant.ru/document/cons_doc_LAW_17176	Number of nights in the country multiplied by per diem rate
6.	Registration fee (RUB)
7.	Tuition fee (RUB)
	Total amount:	руб.
	Not less than 50% of the total amount is co-financed through:	- Income of the facultyн; - Funds of the laboratory, grants, projects; - Funds of the Academic affairs division. Employee’s personal funds and other external funds are not considered as co-financing.

Individual plan is enclosed.

___ __________20___ ___________

(applicant’s signature)

APPROVED

Vice-rector for strategic development _______________ D.V. Sukhushin

(Signature)

Responsible vice-rector ________________ ____________

(Signature, Full name)

Head of division ______________ _____________

(Signature, Full name)

Приложение № 2

Federal State Autonomous Educational Institution of Higher Education

«National Research Tomsk State University»

Individual plan of academic mobility of an employee

Division_____________________________________________________________

Full Name______________________________________________________

Position_________________________________________________________________

Date of birth dd/mm/yy_________________________________________________________

Academic title/rank______________________________________________________

Trip activity type(underline: research/educational/organizational and methodological)

Research areaIn accordance with sub-s 2.6 of the «Regulations»

Country, city/town, receiving organization______________________________________

__________________________________________________________________________

Topic/aim of the trip_________________________________________________________

Coordinator of the event/internship of the receiving organization (Full name, position ,academic title/rank, membership in the leading academic organizations, awards/prizes for scientific work, editorial board membership in the leading peer-reviewed journals)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Trip duration (departure from/arrival to Tomsk):__ ______20___/__ _______20___

Activity duration: from __ ______20___ to __ _______20___

Scientific background

№	Item
	Number of publications in journals indexed in WEB of Science/Scopus/RSCI
	h-index (WEB of Science/Scopus/ RSCI)
	Citation index (WEB of Science/Scopus/ RSCI)
	Number of monographies (in international publishing house written in a language other than Russian/in a publishing house on the list of scientific/technical publishing houses of Russia)
	Number of protected results of intellectual activity
	Level of knowledge of a foreign language
	Other items according to sub-s 4.5,4.6,4.7 of the Rules and Regulations

План поездки конкурсанта

№	List of the topics/areas being studied/researched	Realization
		(giving lectures, participation in a conference/seminar, studying the experience, etc. In accordance with sec. 4.5,4.6,4.7 of the the «Regulations»)

6. Results/obligations to apply materials obtained as a result of the internship/participation in educational, scientific or organizational and methodological activity in TSU:

№	Results/Obligations of the participant of the academic mobility program	Implementation date (-s) (within 1 year from the return date)
	If academic mobility was connected with educational activities the following documents must be submitted: - Titles of classes, lectures, series of lectures given; description of the audience and number of people present; - Results undergraduate/graduate students achieved under scientific supervision of the academic staff member of TSU during the period of his/her academic mobility; - Description of the results of an internship/ professional training (certificate, diploma, final project) with the copies of the certificates/diplomas enclosed; - Planned to be developed/developed as a result of the trip new courses, modules, including the ones in English (number of hours, target audience, time needed for development and implementation). If academic mobility was connected with research/scientific activities the following documents must be submitted: - Information of projects/programs that are being implemented or are planned to be implemented (title, dates); - Titles of reports given at scientific conferences, schools, and seminars. Please provide a conference program and, if applicable, links to the published reports; - Planned/obtained scientific results; - Copies of the articles and materials which were accepted for publication in peer-reviewed journals. Please specify the dates and type of the publication (name of the journal, publication date, quartile, impact factor, and whether the journal is on WOS, Scopus or RSCI). If academic mobility was connected with organizational and methodological activitiesthe following documents must be submitted: - Texts of the approved documents (agreements, study plans, educational programs, schedules, rules and regulations, etc.). Please specify the implementation timeline, number of students involved and justification of the program’s relevance; - Short description of best practices. Please specify when and how they will be applied; - List and description of consulting and expert services provided.

Promotion materials:

In order to improve visibility of the University it’s important to do the following (circle):

5. Organize meetings with the representatives of the PR office of the university.

6. Make information about the lectures you are going to give or meetings you’re going to participate in available on the website of the university.

7. Put in print or online media of the receiving organization information about the university or a link to TSU website (WWW.TSU.RU).

8. Make arrangements with potential QS experts.

___ __________20___ ___________

(Applicant’s signature)

APPROVED

Vice-rector for strategic development _______________ D.V. Sukhushin

(Signature)

Responsible vice-rector ________________ ____________