Organization you are in contact with:

APPLICATION FORM Wide Open Windows YOUTH EXCHANGE Ommen, The Netherlands 28^th October – 6^th November 2014
First name:
Family name:
Sex:
Place and date of birth:
Country
Organization you are in contact with:
Your role in the organization:
How did you find out about this program:
Contact details
Street and number:
City:
ZIP Code:
Phone:
E-mail:
ID number:
Contact person in case of emergency
Name:
Phone:
Address:
E-mail:
Relationship to you:
Specials
Special diets and needs: vegetarian, religious diets, allergies, physical limitations)
What is your present health condition? Detail health problems, injuries and their present state. Specify and describe any medication you take or have taken within the last 6 months.
Questions
Please answer each question in a specific way. Consider, that based on your answers we can develop the program in a way that serves your needs. General answers do not support.
What makes you interested in this exchange? (min. 50 words)
What are the aspects of the peace building you want to work on?
Do you have experience with groups?	yes no
If yes, please describe:
Are you familiar with outdoor tools?	yes no
If yes, please describe your experience with outdoor tools:
Do you have any experience with peace education?	yes no
If yes, please describe:
What working skills do you want to practice and develop? (min. 50 words)
How can you and your organization implement the peace building activities in your country?
Questions, remarks, anything else you want to add:

By submitting this application I, the undersigned, confirm that I have read and understood the Information Letter and the conditions of reimbursement about the exchange Wide Open Windows exchange and I know and accept the conditions of participation.

DATE: SIGNATURE:

Дата добавления: 2015-08-27