ROYAL HOLLOWAY
University of London
Exchange Scheme Application Form
This form should be completed by the applicant and submitted with a complete CV to their Head of Department
Exchange agreements with other institutions may be 'symmetrical' (i.e. exchange of staff between equivalent departments in each institution) or 'asymmetrical' (exchange of staff based in different departments / disciplines). There is no embargo on symmetrical staff exchanges which are cost-neutral but there is a limit to the number of exchanges that can be approved in any single academic year that are asymmetrical and/or not cost-neutral.
Section One: Details of the applicant
Name .. Department .
Date of appointment .. Present post .. ..
End date of appointment ..
(if a fixed term post)
Address for correspondence during period of leave ...
Emergency contact details during period of leave
Name Tel .
Address ...
I am applying for a (delete as appropriate)
'Symmetrical exchange' - complete sections 1 - 4, then forward to HOD for completion of section 6
'Asymmetrical exchange' - complete sections 1 - 5, then forward to relevant HOD's for completion of sections 6 - 7
Name of Exchange Institution ... .
Section Two: To be completed by all applicants
Details of leave taken in the last six years (including sabbatical leave and other exchanges undertaken) (Please provide dates and outcome)
Period of Leave requested for exchange .
Has leave already been granted for this period? YES / NO
If yes, please provide details (including dates) ..
Potential benefits of participation in exchange in terms of
a) Personal career development ..
b) Academic significance of project
c) In relation to departmental / College strategies .
d) Expected outcomes, including completion and / or publication date where relevant
To assist in the assessment of any implications of the proposed leave, please indicate where duties are essential/non-essential and alert the Head of Department to any functions for which special expertise is required
Teaching duties requiring cover during period of absence . . ...
Assessment duties requiring cover during period of absence .
Administrative duties requiring cover during period of absence . ...
Other duties/functions during term of absence (including College Committees, Warden duties, etc) ..
I confirm that I have read and accept the terms and conditions of the exchange for which I am applying.
Signed .. . Date..
Section Three: To be completed by all applicants
Has an exchange partner been found YES / NO
Name of Visiting member of staff (if known)
Department
Correspondence Address ...
Please confirm that written confirmation of his/her agreement has been provided and is attached YES / NO
Section Four: To be completed by all applicants
Does this application have the approval of your Head of Department YES / NO
Are there any departmental resource implications YES / NO
If yes, please provide details and how these are to be addressed ...
Section Five: To be completed by Asymmetrical Applicants only
Does this application have the approval of the receiving Head of Department YES / NO
Are their any receiving department resource implications YES / NO
If yes, please provide details and how these are to be addressed ...
THIS APPLICATION SHOULD BE SUBMITTED WITH A COMPLETE CURRICULUM VITAE
TO YOUR HEAD OF DEPARTMENT
Section Six: For completion by the Head of Department in the releasing department
Does you support this project? Yes / No (delete as applicable)
What are the recommendations/conditions? ...
....
....
Details of the cost of replacement teaching/administration
....
Details of how these costs are to be met .
I confirm that this application has my approval, and that appropriate arrangements have been made to cover for the applicant's duties during their period of leave.
Signed . .... Date .
(Head of Department in Releasing Department )
Section Seven: For Asymmetrical Applications only (for completion by the Head of the receiving department)
Do you support this project? Yes / No (delete as applicable)
What are the recommendations/conditions? ...
....
Details of the cost of replacement teaching/administration being transferred to releasing department.
....
I confirm that this application has my approval, and that appropriate arrangements have been made to transfer monies to the releasing department (if appropriate) and arrangements have been made to receive the visiting member of staff in the department.
Signed . .... Date .
(Head of Department in the Receiving Department )
THIS FORM ONCE COMPLETED SHOULD BE FORWARDED TO THE FACULTY SUPPORT OFFICE.
ENCLOSURES: Curriculum Vitae of Applicant
Statement of support from Host Institution
Copy of exchange partners agreement (if exchange partner known)
Section Eight: Approval by Dean of Releasing Faculty in all applications
The Exchange Scheme application set out above is approved / not approved (delete as appropriate)
The following funding has been granted in relation to replacement teaching/administrative duties
Where a Head of Department is requesting leave please state who is recommended to be acting Head of Department for this period
Comments ..
Signed (Dean of Releasing Faculty) .. . Date
Section Nine: Approval by Dean of Receiving Faculty in 'Asymmetrical' applications
The Exchange Scheme application set out above is approved / not approved (delete as appropriate)
The following funding has been released in relation to replacement teaching/administrative duties
Comments ..
Signed (Dean of Receiving Faculty) .. . Date
A copy of this form once completed should be sent to the Personnel Department