Application form for a Long- Term Training Programme 2018 -2019
Via Experientia - International Academy for Experiential Education
Main contact information
Name
Your answer
Surname
Your answer
E-mail address *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Telephone number (include full international dialling codes)
Your answer
Address
Your answer
Your experience
What is your professional background and what is your current occupation?
Your answer
What are your experiences in working (facilitating, leading) with groups and/or teams?
Your answer
Your learning goals
What is your motivation to take part in this programme?
Your answer
What are your personal goals in this programme? What do you want to learn?
Your answer
Other
Dietary preferences (vegetarian, lactose/gluten intolerant etc.)
Your answer
Do you have any other comments?
Your answer
DECLARATION: I agree that my personal data given in this application form will be held and treated for purposes connected to the contractual relation and to the obligations as per law in force and may be made available to other participants *
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