Application Form 
Academic and Administrative Staff
Mobility Program 	

1.	This form is for the KIMEP University internal use 
2.	All requested information must be complete 

For Academic staff, Contact persons	For Administrative staff, contact person 	
BCB – Dr. Yong Ho Hyun,  office 302-8/adm 
CSS – Dr. Adibayeva, office 205 A/ac
Law – Dr. Luke, office 119/new bld.
LC -  Dr. Shegebayev, office 225/adm 	International Office
(located in the basement of the Dormitory)
Nailya Akhmarova
+7 727 2374800 ext 1085
outgoing@kimep.kz 	
 4.  Documents to submit together with the application:
•	approval from the partner university (letter, email)
•	work plan (teaching/training proposal)
•	Europass CV
•	Proof of the English language proficiency (diploma, official test score certificate, letter    	from the KIMEP Language Center)
•	recommendation from a Head  

First name (as in passport) :

Family name:	
Sex:    Male                 Female	
College: 
	Department:	
Job Position:	# of years of work experience:	
Passport number:	Citizenship:	
Address in Almaty:		
Work tel:

Mobile phone:		Personal e-mail:

Kimep e-mail:	
Person to contact in case of emergency: 
Name:                                                     mobile tel:                                   email:
Address:	

A partner university you are applying for ____________________________________________ 
Grant Program (indicate)__________________________________________________________
Expected period of stay:   _________________________________________________________

MOTIVATION

•	Please, use this field only
•	Please, write your motivation to go abroad (topic of research, training, teaching, etc)
•	Please, describe an expected impact on individual, university, Kazakhstan level
•	Please, describe how you will disseminate the achieved results and help internationalization of education at  KIMEP  

Signature, date_________________________________________