Application form - ACTing for Change
Through this application you are applying to participate in ''ACTing for Change'', a 3-phase Training Program for Youth Workers that will take place between December 2019 and April 2020, in Ommen (the Netherlands) and in each partner country.

Before applying read carefully our Info letter and if you have any questions, feel free to contact our Project Coordinator at cristina.pavel04@gmail.com

By filling this application form you are applying to take part in all 3 phases of the project:

-1st Phase: Training Course [11th - 20th December 2019 (including travel days)] ; Ommen, the Netherlands

-2nd Phase: Local Action Phase [January, February and March 2020] ; each partner country

-3rd Phase : Capacity Building Meeting [5th-10th April 2020 (including travel days)] ; Ommen, the Netherlands


This application form has 4 parts:

1. Personal details
2. Experience
3. Motivation and Desired outcomes
4. Local Action Phase and Extra questions

Read carefully all the questions and take your time to answer them in detail.

Enjoy the ride!
Country of residence *
Name *
Your answer
Surname *
Your answer
Gender *
Date of birth *
MM
/
DD
/
YYYY
Age at the beginning of the project *
Your answer
Nationality *
Your answer
E-mail *
Your answer
Phone number *
With international code
Your answer
Full adress *
Street, number, zip code, city, country
Your answer
Level of English *
Link to FB profile *
Your answer
Do you have any dietary needs? *
All meals will be fully vegetarian. If you have any other dietary need, let us know.
Do you have a health insurance that covers you for the duration of the 1st and 3rd phases of the program? *
Contact person in case of emergency *
Full name, Address, Phone number, Relationship to you
Your answer
Do you have any special need or health requirement?
Medical need, allergies, etc
Your answer
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