Request edit access
New Horizons - Application form
Dear applicant, by filling in this form you are applying for the youth exchange "New Horizons" that will happen from 18th to 28th of September 2018 in Pinerolo, Italy.

By filling this form you declare that you have fully read and understood the content and the conditions of the webpage of the project: http://bit.ly/projectnewhorizons

The project is open for participants resident in Bulgaria, Croatia, Greece, Lithuania, Italy, Spain and Romania.

With your application, you commit yourself for the whole project: preparation, participation in the exchange and follow-up activities.

We will choose as participants the applicants that will look to us more in line with the aim and method of the project, we recommend you to dedicate enough time to complete it fully.

New Horizons Team
Sign in to Google to save your progress. Learn more
Country of residence: *
First name: *
Surname: *
Name you want to be called during the project : *
this will be printed on your name tag
Sex *
Date of birth *
MM
/
DD
/
YYYY
Place of birth: *
Address of residence 1 *
street/square name and number
Address of residence 2 *
ZIP code and city
Email contact: *
Mobile number *
national prefix + number
What is your current occupation or profession? *
What is your level of English? *
Do you need translation? *
What is your level of the following languages? *
I don't speak this language
beginner
basic
intermediate
fluent
Italian
French
Spanish
German
Do you have any physical limitation? *
If yes explain what it is and how it is limiting you.
Do you have any diet or allergy? *
ex. vegan, vegetarian, lactose free, gluten free, allergy to cheese, allergy to bees' bites...
Do you take any regular medication? *
Do you have a medical insurance valid in Italy? *
ex. the European Health Card
Contact in case of emergency *
name, surname, phone number, relation to you
Did/do you face any obstacle/difficulty related with your social environment, culture, identity, family, economical situation or do you live in an isolated place? Do you have chronic health problems? *
Explain briefly
What are the reasons that bring you to apply for this project? *
What do you want to improve or learn concerning your personal development during New Horizons? *
What do you want to improve or learn concerning the topics of culture, cultural filters and cross-cultural communication during New Horizons? *
How do you plan to use what you learn in the project when you go back home? *
What challenges (obstacles, life questions, important decisions, struggles) do you experience in life at the moment? How do you deal with them? *
How do you see yourself? How would you describe your approach towards people /yourself/society? What do you perceive as supportive attitudes/patterns/behaviors of yours? What do you see not working - and what would you like to change? *
How did you find out about this project? *
Facebook, Friends, Someone recommended it to me etc
Comments (optional)
*
I hereby declare that all the above information are true and correct to the best of my knowledge. By submitting this application I confirm that I have read and understood the information written in the webpage of the project: http://bit.ly/projectnewhorizons and the conditions of reimbursement of New Horizons project and I know and accept the conditions of participation. I commit myself to take part for the full duration of the project: preparation, youth exchange and follow-up activities and to participate in the whole evaluation process. I am aware that obtaining a health and a full travel insurance is my own responsibility and at my own expenses. I understand that the information I provided on my special needs does not remove my own personal responsibility for ensuring my own health. I understand and agree that the project may be photographed/filmed and used for publications or websites and social networks to provide visibility to the project, the organizations and the public bodies involved in it.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms