Youth in Action Training Course

Aim Higher: Promoting Safety and Quality in Youth Projects
22nd - 29th August 2013, UK

APPLICATION FORM
PERSONAL INFORMATION
Name and surname Home address Gender Nationality Date of birth Email Mobile telephone

PASSPORT /ID DETAILS Passport/ID number Issued by (place) Do you need a visa to travel to the UK? EMERGENCY CONTACT DETAILS Name and surname Relationship to you SPECIAL REQUIREMENTS Dietary requirements (e.g. vegetarian, etc.) Mobility issues Other ORGANISATION DETAILS (if applicable) Name of organisation Organisation address Medical conditions Telephone number E-mail Issue Date Expiry Date YES NO

Your role in the

Aim Higher: Promoting Safety and Quality in Youth Projects, 22nd - 29th August 2013, UK

Contact person ORGANISATION SHORT DESCRIPTION Please mention: aims; main activities (themes), e.g. sport/health/volunteering/ language learning; target group(s); previous YiA experience, etc.

org. Website Email Telephone number Contact person e-mail

APPLICATION QUESTIONS ...ABOUT THE COURSE Why did you choose this training course? What skills/knowledge/ expertise can you contribute to this training course? What do you expect to take away from this training course in terms of learning? Please explain how this training course may help you and your organisation in the future

DECLARATION I, the undersigned, confirm the authenticity of the data I have provided in this application and will contribute positively to the training course to the best of my ability. I also confirm my permission for the publication of any contributions, photos, videos or other media gathered in the context of this project. Date: Place: Participant’s signature (can be electronic): Only fully completed applications will be accepted.

Looking forward to receiving your application! Consilium ET