Please, answer to the following questions

Youth Exchange

“Be Active, BE Citizen”

Bakuriani, Georgia

25 February - 07 March, 2014

Please, answer to the following questions

Name & Surname:
Name of the organization and Country:
Nationality:		Date of Birth:		Gender:
Complete address:
Postal code:		Town:		Country:
Mobile Phone [with full international dial codes]		Skype:
Email:		Website:

Please, ind icate with X your English proficiency:

Fluent Average Basic Poor

Do you have any special needs or dietary requirements that the host organisation should know about? (E.g. mobility, medical needs, allergies, dietary restrictions, smoker/non smoker etc.)

Please indicate the name and full contact details of a person to be contacted in case of emergency during the training

Name:
Complete address:
Postal code:		Town:		Country:
Phone:[with full international dial codes]		Fax:[with full international dial codes]	-
Email:

Please, answer following questions:

Motivation

Please describe your experience of working in NGO, youth projects or initiatives:

Why do you want to participate in this event?

Expectations

What kind of knowledge & skills would you like to gain by participating in this event?

Dissemination

Please specify your plans for disseminating and applying the experience, knowledge and skills gained during this event:

Дата добавления: 2015-11-04