In the following you apply for the project “Closer Neighbors” introductory seminar “Power of Imagination” taking place in Latvia from July 16 to 26, 2012. Only short listed candidates will be

APPLICATION FORM

In the following you apply for the project “Closer Neighbors” introductory seminar “Power of Imagination” taking place in Latvia from July 16 to 26, 2012. Only short listed candidates will be informed until June 24, 2012.

The introductory seminar is the first step to be admitted as fellow and to receive a project core-funding, a specific capacity building and a mentorship.

Please notice that citizens living only in the North-West regions of the Russian Federation and Kaliningrad are eligible to apply.

The program schedule of project „Closer Neighbors” includes an introductory seminar to the topic Power of the ImagiNation July 16-26, 2012, a kick-off meeting September 1, 2012, project implementation September – November, 2012 and a reflection seminar November 29 – December 2, 2012. Board, lodging and travel costs (up to 70%) for the two seminars will be covered or reimbursed by the organizers.

Personal information
Family name
Given name(s)
Date of birth (dd/mm/yyyy)
Place of birth
Gender (male/female)
Nationality
Occupational status (school student/apprentice/college or university student/employed/ unemployed/trainee)
Current address (street, house number, apartment)
Postcode and city
Region
Telephone (with country and city code)
Cell phone (with country and city code)
Email
1^st native language
2^nd native language
1^st foreign language (fluent/advanced/basic)	Listening	Speaking	Reading	Writing
2^nd foreign language (fluent/advanced/basic)	Listening	Speaking	Reading	Writing
3^rd foreign language (fluent/advanced/basic)	Listening	Speaking	Reading	Writing

Educational background
College, university	Faculty, degree course, subject of study	Diploma received or expected to be received in dd/mm/yyyy)

Additional qualification (e.g. trainings, workshops)
Organization	Training program/subject	Duration

Practical experience (internships, jobs, employments, etc.)
Organization	Responsibilities	Duration

Civic involvement (membership in non-profit organizations, voluntary services, project participation etc.)
Organization	Activities	Duration

What exactly do you want to improve or to change in your personal social environment?

What associations and thoughts come on your mind when you hear “Power of ImagiNation?” Why is this theme actual for your society?

What is your motivation for taking part in the introductory seminar?

What are your expectations of participating in the program?

Other comments:

How did you get to know about Bridge it!? (website, e-mailing, public announcement, mouth-to-mouth etc.)

Please return the filled in application form by email to

[e-mail]

The deadline for submitting your application is June 22, 2012.

Дата добавления: 2015-11-04