YOUR PHOTO

HANDLE WITH VIOLENCE CAUSED THROUGH CULTURAL MISUNDERSTANDING

16 -23 JUNE 2011 | TRENCIN | SLOVAKIA

Personal Details

TITLE Please select one: Mr Mrs Ms

FIRST NAME      

LAST NAME      

DATE OF BIRTH      

GENDER Please select one: female male

LANGUAGE      
ABILITIES
     

MOBILE PHONE      

E-MAIL      

ADDRESS      

PASSPORT Nationality      

DETAILS Number      

Place Issued      

Date Issued      

Expiry Date      

NGO
     
NAME OF
YOUR NGO      

Country/ City/ Adress / Website /      

Email
     

Your position in the group      

 Motivation, Need, Knowledge, Contribution

1. Please describe yourself in a few words:

     
2. Please give us some further ideas of your background: education, past work experience, life experience,etc…:
     
3. What is your motivation to join this youth exchange? What expectations do you have towards this youth
exchange?
     
4. What experiences do you have with the Youth in Action Programme (took part in activities, seminars, youth
exchanges, etc)?
     
5. Are you familiar with Youthpass?

Special Needs, Emergencies, Conditions

Special Needs or Requirements:

Please let us know if you require any special arrangements or if there are things we need to be
aware of (vegetarian food, allergies, impediments, .. ) :
     

Please indicate the name and full contact details of the contact person in case of emergency during the
training course:

Name      
Complete address      
Postal code       Country      
Phone Fax
[with full international dial codes] [with full international dial codes]
           
E-mail      
International Travel and Visa: Schedule and Costs

Please indicate if you need a visa: yes no

Please indicate your travel itinerary to Trencin / Slovakia and your expected travel costs, including – if
applicable - costs for visa and vaccination:

     
     
     
     
     
 Your notes