Application Form Partners for Youth Exchange (A 1.

1)

IDENTIFICATION OF THE PROMOTER Promoter Promoter’s legal name (national language): Promoter’s legal name (latin characters): Acronym, if applicable: National ID number, if applicable: Department, if applicable: Legal address: Postal code: City: Country: Region: Web site : Email: Telephone: Fax: Person authorised to legally commit the promoter (legal representative) Title: Family name: First name: Position in the organization: Email: Telephone: Fax: Person responsible for the implementation of the action (contact person) Title: Family name: First name: Position: Email: Telephone: Fax: PART B. PROFILE OF THE PROMOTER Status private (PR) public (PB) Type private organization public body

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Activity level local (L) regional (R) national (N) european (E) international (I) Objectives and activities of the promoter Please provide a short presentation of your organisation/ group (usual activities, affiliations, etc.) in relation to the field covered by the project.

Please describe the role of your organisation/group in the project. Please specify how can you contribute directly in our project? Specify. (ex: hold workshops, provide equipment, ensure the results etc.)

Other community funding Please give information about any type of group has received/ applied for in the last Programme or Identification/ Initiative contract number

Community grant your organisation/ financial year. Contracting Title of the project promoter

*add more rows if needed Motivation (Optional) Which is your motivation to apply for this project?

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Write us the travel costs from your place to Bucharest, Romania: (*Bucharest-Iasi – almost 40 Euro, both way, with bus or train) Organizatio n name nr. of persons from to Means of transport cost Other things:

Do you need visa for Romania? Please estimate the costs for one person.

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