Fill in, print, sign, scan and submit the application form to the Nordplus secretariat: hilde.dahlstrom@nla.no

Purpose of the trip? (a brief explanation, max 200 words)

Amount? Maxbeloppet för uppehälle är 20 Euro per dag, 70 Euro per vecka eller 200 Euro per månad. Maxbeloppet för resor tur och retur är 1.300 Euro för Grönland, 660 Euro för Island och Färöarna. För övriga nordiska länder är maxbeloppet 330 Euro.

Name:

Home institution, program and year of study:

Date of birth

Citizenship:

Home address:

Host institution and country to visit:

Contact person at receiving institution:

Dates of arrival and departure (and total number of days):

Bank name and branch:

Full address of the bank:

IBAN/Swift:

I accept the Nordplus grant and agree to the following terms and conditions:

1. I will use the grant only to cover travel expenses related to this study trip.

2. The study trip is part of the study program at the home institution.

3. The study trip should last no less than 5 days and no more than 1 month.

4. If the trip is cancelled or interrupted, I will reimburse the grant.

5. Upon my return, I will hand in a short report on my stay (appr. 500 words) to the Nordplus secretariat. The report may be published at nordiskjournalistutbildning.org.

STUDENT: I confirm that all information given in this application is correct.

Place and date                                 Signature of the student

EDUCATION: I confirm that the student’s stay is part of our study program (home institution).

Place and date                                 Signature