TEVIP 2019 Mobility Application form
Deadline for application: 1st of May 2019 23h59 CET
More info: ufficio@agapecentroecumenico.org (+39) 0121 807514
Name and surname *
For legal purpose we need your details as shown on you ID
Your answer
Gender
Sex *
Date of birth *
MM
/
DD
/
YYYY
Place of birth *
Your answer
Nationality(ies) *
Your answer
Profession
Your answer
Full address *
Your answer
Post code *
Your answer
Town *
Your answer
Country *
Your answer
Telephone
Your answer
Emergency contact *
Name, mobile phone
Your answer
Email *
Your answer
Spoken language(s)
Your answer
I wish to be in a room:
At Agape we offer a flexitarian diet:
Allergies and/or food intolerances
Your answer
Other notes:
Your answer
I need an official invitation to obtain a visa
If yes, please indicate additional data:
Passport number // Date of issue // Issuing authority
Your answer
Do you have any previous experience in non formal education at international level and/or in working on values? If so please describe briefly, if not you are also more than welcome *
Your answer
What are you doing in your daily life? *
Your answer
What are your expectations to apply for this project? *
Your answer
Any other comment you would like to share with us
Your answer
Privacy disclaimer
I, the undersigned, having read the Privacy Notice on the processing of personal data:
Give my consent to the processing of special categories of data (sensitive data), necessary to achieve the purposes stated in this Privacy Notice. (Failure to provide consent won’t make it possible to perform the contract). *
Required
Give my consent to the use of my identification data (image) for audiovisual footages and pictures which may be published on the website, blog or social media pages of the Controller, or on information and advertising flyers, printed material or any other communication media. (If you don’t provide consent, it will still be possible to perform the contract).
Give my consent to the use of my contact data for information purposes related to the Controller’s activities, for which I am entitled to give my consent, through information communications (sent via e-mail and/or through the Controller’s official social network pages), including the newsletter. (If you don’t provide consent, it will still be possible to perform the contract).
Give my consent to the use of my contact data (first name, last name, address, phone number, and e-mail) for drafting a contact list to be distributed to participants of the camp I’m attending and which contains the participants’ contact details. (If you don’t provide consent, it will still be possible to perform the contract. However, if you don’t provide the authorisation, you won’t be given the contact list).
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