Selection form for the Youth Exchange "Make Your Impact"
Project dates: 2019.05.11-05.15 (5 days)
Venue: Mažeikiai, hotel "Palma", Respublikos st. 27, Mažeikiai.
Contact person: Gabrielė Milienė, stovykladraugai@hotmail.com, +370 657 53131

More info about the project: http://stovykladraugai.lt/zinios_apie_socialini_versluma_lietuvos_ir_lenkijos_jaunimui-n211-p0

Please take note of the following conditions that will apply while participating in the youth exchange:
1. I commit myself to participate in the whole process, including:
·        to prepare for the national evening;
·        to take part in the full duration of the youth exchange, including to be present in all the activities unless I am sick;
·        to contribute to dissemination of project results.
2. 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.

Your provided information will be used only for contacting you for this project.
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Name and surname *
Birth date *
MM
/
DD
/
YYYY
E-mail *
City/town *
Phone number *
Your English language skills: (at least average English speaking skills are required to participate in this YE) *
Do you have any allergies or food requirements? Please, be as specific as possible. *
Describe yourself (what do you like to do, what are your hobbies, etc.)
Why should you be selected to be a part of this project?
Your Facebook account - to be able to find you and add you on the project group. *
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