A PROGRAMME OF AN EXCHANGE STAY AT A PARTNER UNIVERSITY 		

	
1. Name and surname:	     	
		
2. Academic degree:	     	
	
3. Home institution:		
a)	University name:	Masaryk University 	
b)	Faculty:	     	
c)	Department:	     	
d)	E-mail:	     	
e)	Tel. / fax:	     	
	
4. Profession:	     	
     	
	
5. Knowledge of foreign     languages:		
	     	
	     	
	     	
	
6. Number of days of the visit:	     	
	
7. Proposed period of the visit:	     	
	
8. University, department/institute and name/names of partners to be visited		
     	
     	
     	
     	
	
9. Topics to be discussed, possible lectures to be delivered:	
     	
     	
     	
     	
     	
     	

	
Date:	     					
	signature