GreenPact Application Form
Participant's and team application for GreenPact youth exchange that will take place in Alsótold, Hungary, 20-29 October 2016.
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Country *
You apply to be *
First name
Family name *
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
Date and place of birth *
Address (zip code, country, city, street, number) *
Phone number *
Email *
Occupation or profession *
Do you have any special diet? *
If yes, please specify
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. *
Level of English *
How did you find out about this exchange? * *
Contact person
In case of emergency
Full name *
Address *
Phone number *
Relationship to you *
Sending organisation
Name of the organisationYour answer
Contact person's name and positon
Your role in the organisation
Learning Needs
Why are you interested in this program? How are you connected with the topic of this youth exchange? (min. 50 words) *
What professional and personal skills do you want to practice and develop? (min. 50 words) *
What results do you expect concerning your professional and personal development? min. 50 words) *
In which areas of life do you want to use what you learn here and how? (min. 50 words) *
I confirm that I have read and accepted the Information letter and the conditions of reimbursement the exchange GreenPact. *
I accept the conditions of participation *
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