Youth Exchange "StarTrek"
Viggiano | Italy, 6 - 14 June 2019
Email address *
Name *
Your answer
Surname *
Your answer
Date of Birth *
Gender *
Mobile phone (with international code) *
Your answer
City of Residence *
Your answer
Citizenship *
Your answer
ID/Passport number *
Your answer
English Level *
Facebook Profile Link *
Your answer
What is your motivation to participate in this Youth Exchange? *
Your answer
Which are your expectations of this Youth Exchange? *
Your answer
Previous International Experience? *
Your answer
Position in the group that I apply for: *
Do you consider yourself as young person with fewer opportunities to take part in this project? If yes, what can the organisers do in order to make your participation possible? *
Your answer
Special Needs or Requirements. Please let us know if you require any special arrangements or if there are things we need to be aware of (vegetarian, allergies, impediments ...) *
Your answer
Please indicate the name and full contact details of a person to be contacted in case of emergency during the youth exchange (Name, relationship, phone, e-mail) *
Your answer
Please take note of the following conditions that will apply as you send this application form and since you will be accepted to take part in this youth exchange:

1. I have read carefully the practical information regarding this Youth Exchange and I am aware about the conditions of participation in the project.
2. I commit myself to participate in the whole process, including:
• to take part in the full duration of the Youth Exchange
• to participate in the whole evaluation process
• to send feedback text and photographic material to the sending organization (Trikala se drasi-TrikalAct)
3. I am aware that obtaining a health and a full travel insurance are 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.
4. If I cancel my participation, I abide myself to inform about it immediately so the organizers can find a suitable replacement.
I have read and agree with the conditions above *
A copy of your responses will be emailed to the address you provided.
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