Application form - "We Choose to Game-If-I"

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Dear applicant, by filling in this form you are applying for the project "We Choose to Game-If-I" that will happen from 30 September to 9 October in Amarante, Portugal

By filling this form you declare that you have fully read and understood the content and the conditions of the info pack of the project: https://bit.ly/WeChoosetoGame-If-I

With your application, you commit yourself to take part in the whole duration of the project and in all phases of implementation: preparation, implementation and follow-up part.

We will choose as participants the applicants that will look to us more in line with the aim and method of the project, the more motivated and pro-active. We recommend you to dedicate enough time and care to complete the application form fully.

We Choose to Game-If-I

First name: *

Surname *

Date of birth: *

YYYY

Place of birth *

Write the name of the city and of the country where you born

Nationality *

How do you identify yourself concerning your gender? *

Providing only "male" and "female" as options could be limiting for somebody

Address of residence 1 *

write the name of the STREET and the NUMBER where you are officially living

Address of residence 2 *

write the ZIP CODE and the name of the CITY where you are officially living

Email contact: *

We will communicate with you through this contact

Mobile number *

national prefix + number

What is your current occupation or profession? *

What is your level of English? *

beginner

basic

intermediate

fluent

Do you have any physical limitation? *

If yes, please explain what it is and how it is limiting you (what you can do and what you can't do because of it).

Do you have any allergy? *

ex. lactose free, gluten free, allergy to mushrooms, nuts or other food, allergy to bees' bites... Keep in mind that for the organizers taking care of your diet requires extra efforts.

Do you take any regular medication? *

If yes explain what medication

Do you have a medical insurance valid in the country where the project will happen? *

ex. the European Health Card

Contact in case of emergency *

Write the name, surname, phone number and what relation this person has with you

Do you consider that in your life you face some of the following obstacles: *

Disability / special needs – e.g. mental (intellectual, cognitive, learning), physical, sensory or other disabilities

Health problems - e.g. chronic health problems, severe illnesses or psychiatric conditions

Educational difficulties - e.g. learning difficulties, early school-leaver, poor school performance

Cultural differences - e.g. immigrant, refugees or with immigrant or refugee family background, belonging to a national or ethnic minority

Economic obstacles - e.g. low standard of living, low income, dependence on social welfare system, long-term unemployment or poverty, debt or financial problems

Social obstacles - e.g. facing discrimination because of gender, ethnicity, religion, sexual orientation

Geographical obstacles - e.g. from remote or rural areas, young people living on small islands or in peripheral regions, young people from urban problem zones, young people from less serviced areas (limited public transport, poor facilities)

None of the above applies to me

Other:

Required

Is New Wellness Education annual membership of 50€ a REAL obstacle for you to participate in this PROJECT? If yes explain why *

Consider the money you will save by being in the project. On the following web page you can check the food overage minimum price per day in your city and country https://www.numbeo.com/food-prices/

Are you applying as Participant or as National Leader? *

Participant

Leader

Participants or leader

What is that calls you to apply for this project? Why do you want to participate? *

What do you want to improve or learn during the project? *

Be specific: it support us to understand your expectations and it support yourself in approaching the project with a pro-active attitude and fulfill those expectations (this project is based on the methodology of learning through experience, don't participate only as a receiver!)

Do you have previous experiences in non-formal education? Ex. participating or organizing workshops for young people based on non-formal education methods? Share about them *

Which of your competencies regarding the main topics of the project could you share with the other participants? *

How would you like to use what you will learn in the project when you go back home? *

Have you participated in any project supported by European funds before? If yes, tell us about them and about the role you had in them *

(e.g. Youth Exchanges, Training Courses, European volunteering, Erasmusintern etc.)

How did you find out about this project? *

Facebook/web page/newsletter of my sending organization; on a group related to international mobility (write the name), on a youth mobility portal (write the name), in a youth centre, from my friend John Brown; Mary Smith recommended it to me etc.

Is there anything else that you want to add? (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 web page of the project: https://bit.ly/WeChoosetoGame-If-I, the conditions of reimbursement and I know and accept the conditions of participation. I commit myself to take part for the full duration of the activity: preparation, youth exchange and follow-up phase and to participate in the whole evaluation process; in case I will break this commitment I will renounce to the travel reimbursement. I am aware that obtaining health and full travel insurance is my own initiative 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. *

I confirm

Required

I hereby declare that I understand and I commit to the safety rules related to Covid-19 prevention on power in the country where the project is implemented, that can be checked here: https://reopen.europa.eu. I understand that if I will not apply myself those safety rules the organizers will be obliged by law to inform the local authorities and, in case I will break the rules again, I will have to leave immediately the project.I understand as well that the common safety rules don't remove my own self-responsibility and I understand that the risk of contagions, despite being reduced to the minimum, still exist. I commit myself not to take any legal action towards the organizers, the coordinating organization, New Wellness Education or the partner organizations in case I will get infected by the COVID-19 during the project or while travelling to/from the youth exchange. *

I agree

Required

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