Internship, fieldwork, and conference visits

First name *

Last name *

University e-mail address *

Cell phone number

You are a *

Student number

name / location internship project, conference or other reason for travel

Is the internship organised by Leiden
University?

Contact details internship organiser

Who organises the internship?

Start date internship

dd/mm/yyyy

End date internship

dd/mm/yyyy

Name internship supervisor

Contact person in case of emergency

Phone number emergency contact
person

What will you do?

Conference visit

Fieldwork

Other, namely Other, namely

Conference name

City

Country

Start date

dd/mm/yyyy

End date

dd/mm/yyyy

If you are not going on fieldwork yet, you may ignore the following fields. Please click the Send button at the bottom of this form.

If you take students with you on fieldwork, please note that, before completing this form, you will
need to upload this excel file with their names, student numbers, e-mail addresses, and emergency
information.

If you do not have this information as of yet, please do not continue filling in this form.

Will you be accompanied by students?

Upload a file (word/excel) with the
accompanying students' names, student
numbers, and e-mail addresses

Name / location field work project

Location, address and phone number

Start date internship

dd/mm/yyyy

End date internship

Excavation leader phone number

Assistant Excavation leader phone number

Location of residence: address and phone
numbers of hostel/hotel/excavation house

Departure date, flight number(s), destination

Return date, flight number(s), destination

* = Input is required