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APPLICATION FORM Wide Open Windows YOUTH EXCHANGE Ommen, The Netherlands 28th October – 6th November 2014 | |
First name: |
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Family name: |
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Sex: |
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Place and date of birth: |
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Country |
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Organization you are in contact with: |
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Your role in the organization: |
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How did you find out about this program: |
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Contact details | |
Street and number: |
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City: |
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ZIP Code: |
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Phone: |
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E-mail: |
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ID number: |
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Contact person in case of emergency | |
Name: |
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Phone: |
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Address: |
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E-mail: |
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Relationship to you: |
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Specials | |
Special diets and needs: vegetarian, religious diets, allergies, physical limitations) |
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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. |
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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) |
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What are the aspects of the peace building you want to work on? |
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Do you have experience with groups? | yes no |
If yes, please describe: |
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Are you familiar with outdoor tools? | yes no |
If yes, please describe your experience with outdoor tools: |
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Do you have any experience with peace education? | yes no |
If yes, please describe: |
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What working skills do you want to practice and develop? (min. 50 words) |
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How can you and your organization implement the peace building activities in your country? |
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Questions, remarks, anything else you want to add: |
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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:
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