PLACEMENT REPORT

In order to provide a methodical source of information about their placements, beneficiaries are asked to complete this form as a record of their experiences during the traineeship. The promoter should attach this training report to the final report on the whole of the mobility programme to be submitted to DG XXII-Leonardo da Vinci Programme. 

You should use one of the official languages of the European Union to fill in the application form. These languages are English, French, German, Danish, Dutch, Finnish, Greek, Italian, Portuguese, Spanish and Swedish.

1. PERSONAL DETAILS

1.1. Name:

1.2. Sex:	 male			 female

1.3. Date of birth:  …………

1.4. Fields of study:

 engineering and technology
 pure or applied sciences (mathematics, physics, chemistry, biology)
 economics, commerce, marketing
 social sciences
 other (please give details)___________________________________________________

1.5. Status:

 student
 young graduate
 doctorate

2. SENDING ORGANISATION

2.1.  Name of university/sending organisation:	

2.2.  Name of contact person: 	

2.3.  Tel/Fax: _______________________________ E-mail:	

2.4.  Address: 	

3. HOST ORGANISATION

3.1. Name and county of the host organisation: 	

3.2. Name of contact person/tutor:	

3.3. Tel/Fax:__________________________________E-mail:	

3.4. Address:	

3.5. Type of organisation : 			3.6. Sector of activity :
(you may tick several)

  Public or nationalised company			Production
  Multinational			Construction
 Small and Medium-Sized Company			Trade/services
     (under 250 employees)
  Large company			Food industry
 Other:…………………	.		Banking/Insurance
			Other……………………………

4. LENGTH OF placement:

 ……….. months:……….. from:……………… to:………………………..

5. HOW DID YOU FIND OUT ABOUT THIS TRAINEESHIP?

5.1.   by myself

5.2.  through the sending organisation 

5.3.  through my university

5.4.  through the host organisation

5.5.  through other channels (specify)

	

6. CONNECTION WITH YOUR STUDIES

What is the link between this placement and your studies? 
Please provide more details under item 9.1

6.1.		The placement forms an integral part of my course.

6.2.		This traineeship will count towards my academic qualification: _________credits.

6.3.		This training is a specific project which I can include in my theoretical studies.

6.4.		Credits negotiated with my teacher: _______________ credits.

6.5.		It will be recognised by my employer for professional purposes.

6.6.		It will not be recognised in any particular way.

6.7.		Other aspects ? (specify):

7. FINANCIAL ASPECTS

If you are using currency other than the Euro, please make clear which currency is being used!

7.1. Income throughout the placement:

I have had a Leonardo da Vinci grant of a total of :                  _______ € /  __________
Received as follows:   payment in advance                                _______ € / __________
                               balance                                                       _______ € / ___________
I have had a company contribution/salary/wages/pocket money *:_____ €/  __________
*delete as appropriate                                                                          

Other forms of income:                                              Amount:                             Source:

 Free accommodation. (Give the approximate value)  ____________ € /or _______   ______________
 One free meal per working day	“           ___________ € /or_______   ______________
 All meals free	“           ___________ € /or_______   ______________
 Free travel to/from my place of work 	“           ___________ € /or_______   ______________
 Other form (specify)  ______________ 	“           ___________ € /or_______   ______________
	Total:   ___________ € /or_______ (other currency)
7.2. Expenditure during the whole of the placement:

Travel	________________ € /      
Accommodation	________________ € /        
Subsistence	________________ € /        
Language training	________________ € /        
Insurance	________________ € /       
Other expenditure	 ________________ € /        

             Your total expenditure: ________________ € /       ________________

Other remarks about the financing of the placement: 	

8. OUTCOME OF THE PLACEMENT

8.1. 		My practical knowledge in the field was increased

8.2.		I became aware of my career prospects

8.3.		The traineeship helped to complete my theoretical studies

8.4.		I contributed to the training of the employees of the host company 

8.5.		I was able to finish my own work project

8.6.		I taught a foreign language to the employees of the host company 

8.7.		I was able to try out my theoretical knowledge in practice

8.8.		I introduced new methods/technologies to the host company

8.9.		During my placement, I was able to contribute to cooperation between my university and the host organisation/company

8.10.		The placement has improved my chances of finding employment

8.11.		I learnt to work with people from a foreign cultural background and improved my intercultural skills

8.12.		During my placement I gained a better understanding of the concept of European citizenship 

8.13.		During my placement, I improved my language skills (in the language of the host country)

8.14.		Other (specify) .............................................................................................

9.	Give more details about the following points and illustrate with concrete examples/observations.

9.1. 	Connection with your studies (item 6).
How did the placement help you in your studies or your career ? How will it be recognised ?

9.2. Outcome of the placement (item 8).
Give details of the outcome you indicated under item 8.

	

10. PRACTICAL ASPECTS 
Give a brief description (a few lines) of how the above activities were organised, drawing attention to the strengths and weaknesses. Use an additional sheet but do not forget to give the number to which the response refers. 
10.1.	Information about the placement and how the selection of participants was organised;

10.2.	Language/cultural preparation ;

10.3	Guidance with the work and tutorial support in the host organisation;

10.4.	Living and working in another country;

10.5.	Monitoring and assistance from your sending university/host organisation;

10.6.	Evaluation of your training;

10.7.	Contract: what sort of contract did you sign for your placement?

11. GOOD/BAD EXPERIENCES
Describe briefly any good/bad experiences you had during your placement. Give concrete examples/information and explain why what you are describing here is important to you.
11.1. Good experiences:

11.2. Bad experiences:

	
12. SIGNATURE

_________________________________________

Signature:                                                                Place and date: