GreenPact Application Form
Participant's and team application for GreenPact youth exchange that will take place in Alsótold, Hungary, 20-29 October 2016.
Country *
Your answer
You apply to be *
First name
Your answer
Family name *
Your answer
Gender *
Please mark if you face any of the following situations (This information will be handled confidentially, it is necessary for the project setting)
Mother's name
Your answer
Date and place of birth *
Your answer
Address (zip code, country, city, street, number) *
Your answer
Phone number *
Your answer
Email *
Your answer
Occupation or profession *
Your answer
Do you have any special diet? *
If yes, please specify
Your answer
What is your present health condition? Detail health problems and their present state. Specify and describe any medication you take or have taken within the last 6 months. *
Your answer
Level of English *
How did you find out about this exchange? * *
Your answer
Contact person
In case of emergency
Full name *
Your answer
Address *
Your answer
Phone number *
Your answer
Relationship to you *
Your answer
Sending organisation
Name of the organisationYour answer
Your answer
Address
Your answer
Website
Your answer
Email
Your answer
Phone
Your answer
Contact person's name and positon
Your answer
Your role in the organisation
Your answer
Learning Needs
Why are you interested in this program? How are you connected with the topic of this youth exchange? (min. 50 words) *
Your answer
What professional and personal skills do you want to practice and develop? (min. 50 words) *
Your answer
What results do you expect concerning your professional and personal development? min. 50 words) *
Your answer
In which areas of life do you want to use what you learn here and how? (min. 50 words) *
Your answer
Submission
I confirm that I have read and accepted the Information letter and the conditions of reimbursement the exchange GreenPact. *
Required
I accept the conditions of participation *
Required
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