Culture for Local Development Program 6-14.06 2019 Application Form
First name *
Surname *
Date of birth *
Sex (Male/Female) *
Nationality *
E-mail *
Phone number *
Occupation *
Affiliation (school, university, organization, other) *
Describe your motivation for participation in "Culture for Local Development" project. (max. 500 characters) *
What are your expectations of the project? (max. 500 characters) *
What does culture for local development mean to you? *
What could be a potential cultural activity in your local environment? (max. 500 characters) *
What idea for the project would you like to develop during the workshops? (max. 500 characters) *
Please, describe your experience in local cultural projects and paste links to your projects, events, initiatives etc. (max. 500 characters)
NOTE: There’s also a possibility to send your work via e-mail
Language competences: English - working language of the project *
According to the Common European Framework of Reference for Languages
Language competences: Mother tongue
Language competences: other languages
Special needs (diet etc.)
Where did you get information about the "Culture for local development" from? *
I declare my participation in entire project. In the case of the resignation after my entry has been accepted, I will inform the organizers no later than 10th May 2019. *
Since 25 May 2018, the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46/EC (GDPR), has been in force. For this reason, please be informed that we, Europejskie Centrum Solidarności (ECS; European Solidarity Centre) with its registered office at pl. Solidarności 1 in Gdańsk, Poland, e-mail: along with Instytut Adama Mickiewicza (IAM; Adam Mickiewicz Institute) with its registered office at ul. Mokotowska 25, Warsaw, Poland, e-mail: will be the Controllers for your data. Contact data to both Data Protection Officers: for ECS:, for IAM: Your data may be disclosed to recipients such as public authorities which may receive personal data in the framework of a particular inquiry or/and to recipients, with which Controllers contained any kind of Processing Agreement. Your freely given consent in accordance with article 6 point 1 letter a) of the GDPR is the legal basis for processing your personal data. Data processing is necessary for us to perform the Culture for Local Development program. In accordance with GDPR, you have: a) the right to access your data and obtain a copy of them, b) the right to have your data rectified (corrected), c) the right to have your data erased, to restrict their processing, d) the right to object to data processing, e) the right to data portability, f) the right to lodge a complaint with a supervisory authority. Your personal data will be stored since your freely given consent until withdrawal of the consent given (without affecting the lawfulness of processing based on consent before its withdrawal). Your consent can be withdrawed at any time without affecting the lawfulness of processing based on consent before its withdrawal. Provision of your personal data is not mandatory, however requred for participation in the Program. *
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