Expression of Interest of HEI Initiative


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	APPLICANT DETAILS

	First Name

	Last Name

	Prefix (van der, de , le , la)

	Suffix (Msc, Bacc, PhD)

	Your Job Title

	Email Address

MAIN CONTACT, ORGANISATION DETAILS, AND REASON FOR COLLABORATION

Main Contact Person Details

Main Contact - name

Please enter the name of the main contact person

Main Contact - Surname

Please enter the surname of the main contact person.

Main Contact - phone number

Please enter the phone number of the main contact person.

Main Contact - email

Please enter the email address of the main contact person.

Information on the Organisation applying

Organisation Name

Please enter the name of the organisation (in English) that wants to collaborate.

Organisation Address

Please enter the street address of the organisation.

Organisation Type

select

Higher Education Institutions (HEIs) holding a valid Erasmus Charter for Higher Education (ECHE) with its affiliated entities (if any) as full or associated partner, coordinated by an HEI
Intermediary organization or association which represent Higher Education Institutions
Business (including social enterprises)
Research Institute
City or Region or NGO
Individual
Other

Please indicate the type of your organisation

If you selected "Other" above, please describe the organisation

If you selected "Other" above, please describe your kind of organisation

KIC Membership

not a KIC member	EIT InnoEnergy
EIT ClimateKIC	EIT Manufacturing
EIT Digital	EIT RawMaterials
EIT Food	EIT Urban Mobility
EIT Health

Please select the KIC that your organisastion is a member of, or "not a KIC member".

Department Name

Please enter the name of the department of the main contact person (in English).

Department Address

Please enter the street address of the department.

Home Page

Please enter the home page address (URL) of the organisation

Further involved departments

Please list any further deparments of your organisation that are involved. Should there be none, please enter "none".

HEI Innovate Self Assment performed?

Yes

Please indicate whether you already performed the HEI Innovate self assessment for your organisation.

Collaboration Topic and Interest

Collaboration option

select

HEI Innovate initiative

Please select ther collaboration option. Currently, there is only one available.

Improvement domain(s)

Domain 1 – Fostering institutional engagement and change

Domain 2 – Strengthening partnerships (knowledge triangle integration)

Domain 3 - Contribution to developing innovations and businesses

Domain 4 – Enhancing the quality of innovation and entrepreneurial education

Please select the improvement domains for HEI you are targeting (not more than 2).

Specific interest in the selected area of collaboration

Please describe your specific interest for the collaboration

Specific capabilities in the selected area of collaboration

Please describe the specific capabilities and/or competencies you/your organisation has in relation to the intended collaboration and how you want to contribute.

Your HEI Vision

Please describe briefly your vision for the collaboration.




	Email Address