Participation Forms and Records

Draft for approval · ARCTIS-12 · Version 0.1
Prepared 19 October 2026 · Approval and effective dates: pending

This working forms pack supports membership applications and individually agreed programmes. Complete only the relevant forms. Required University or sending-institution documents take precedence.

1 Membership application

Full name: __________________________________________

Institution and role or professional status: __________________________________________

Contact email: __________________________________________

Research or teaching interests: __________________________________________

Proposed contribution and availability: __________________________________________

Optional professional profile or ORCID: __________________________________________

Applicant statement: I confirm that the information is accurate and that I have read the applicable membership guidance and Privacy Policy. I understand that submission does not itself confirm admission.

Name and date: __________________________________________

Submit through https://arctiscenter.com/become-a-member/ or send the completed form to y.kapranov@vizja.pl. Do not include identity documents or sensitive personal information.

2 Individual programme

Programme type: staff development / virtual mobility / student internship

Participant and institution: __________________________________________

Academic contact and supervisor: __________________________________________

Dates, format, working language and total agreed hours: __________________________________________

Objectives and learning or research outcomes: __________________________________________

Activities, milestones and meeting arrangements: __________________________________________

Required resources, permissions and institutional documents: __________________________________________

Final output and assessment criteria: __________________________________________

Practical conditions and responsibilities confirmed before the start: __________________________________________

Participant confirmation and date: __________________________________________

Supervisor confirmation and date: __________________________________________

Institutional approval, where required: __________________________________________

3 Activity log

Participant and programme: __________________________________________

For each entry record: date; activity; work completed; hours where required; evidence or output; supervisor feedback.

Entry: ____________________________________________________________________

Total verified hours, where applicable: __________________________________________

Participant and supervisor confirmation with dates: __________________________________________

4 Final report and supervisor assessment

Participant, programme and actual dates: __________________________________________

Objectives achieved and supporting outputs: __________________________________________

Changes, unfinished work and reasons: __________________________________________

Learning or research reflection and next steps: __________________________________________

Supervisor assessment against agreed criteria: __________________________________________

Completion outcome and any outstanding requirements: __________________________________________

Verified hours, if required: __________________________________________

Participant and supervisor names, signatures and dates: __________________________________________

Any sending-institution recognition is recorded separately by that institution.

5 Optional publication permission record

Use only when a specific public profile, photograph, recording or contribution is proposed. This record does not replace any required University consent or copyright form.

Contributor and exact material: __________________________________________

Publication purpose, channel, audience and proposed licence if any: __________________________________________

Approved scope and any exclusions: __________________________________________

Applicable University permission or consent record and date: __________________________________________

Contact for questions and handling withdrawal or removal requests: __________________________________________

Publication must not proceed until the applicable arrangements are complete. Declining optional publicity does not itself prevent membership.

6 Internal membership confirmation

Applicant and application date: __________________________________________

Decision and date: __________________________________________

Reason or agreed participation route: __________________________________________

Named contact and any activity-specific conditions: __________________________________________

Decision communicated by and on: __________________________________________

Keep this completed record internally. Do not publish applications, signatures, contact details or the membership register.

7 Status

These templates are drafts for approval. A blank template is not an agreement, admission decision, certificate or completed assessment. Obtain all required confirmations through approved institutional channels.