ACT - Active Citizens of Today! - Czech Republic
ERASMUS+: Youth programme, Key Action 1, Training course
Dates: 20.-28. 3. 2019
Venue: Lednice, Czech Republic
Name *
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Surname *
Your answer
Gender *
Date of birth *
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Age at the time of the project: *
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Citizenship *
Address *
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Current country of residence *
Your answer
Email address *
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Mobile phone number *
Your answer
Emergency contact (first name, surname, phone number, email address, languages spoken), relationship to you (e.g. brother) *
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Facebook profile link: *
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Passport expiry date (if you do not have a valid passport, please do not apply for this project): *
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DD
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YYYY
Which town/city will you travel from? *
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English proficiency level: *
Please tell us about your proficiency in other languages (if any): *
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Special Needs: *
Required
If you are allergic to something, you are taking a certain medicine, or you have reduced mobility, etc., please let us know here
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Are you participant with fewer opportunities? If so, please specify. *
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Your SENDING organisation name *
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ORGANIZATION INFORMATION [i.e., the (non-profit non-governmental) organization that you actively work/volunteer for, IF ANY). Please leave blank you if you are not active in any non-profit non-governmental body]:
Name of organization
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Address
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Website
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Your position in organization
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How will your organization/association benefit from your participation in this activity?
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