Youth Exchange UPCYCLE YOUR LIFE - Application form
Scambio Giovanile internazionale a Poronin (POLONIA)
6-12 Ottobre 2019

ATTENZIONE! Il modulo può essere compilato anche in lingua italiana
First Name *
as on your passport
Family Name *
Surname as on your passport
Nationality *
Date of birth *
MM
/
DD
/
YYYY
Gender *
Complete home address *
Postal code *
Town *
Country *
Phone (preferably mobile) *
with full international dial codes
Email *
Language(s) abilities
Please mention all languages in which you are able to work and indicate your level for each of it.
English *
(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)
Basic
Mother Tongue
Language 2
Please specify
(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)
Basic
Mother Tongue
Clear selection
Language 3
Please specify
(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)
Basic
Mother Tongue
Clear selection
Do you have any special needs or requirements that the host organisation should know about?
E.g. mobility, medical needs, allergies, dietary restrictions (vegetarian, vegan, etc.), smoker/non-smoker
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