Application Form for the Youth Exchange "Nikolas' Helpers"
The youth exchange "Nikolas' Helpers" will take place on 11-21 December in Okhtyrka, Sumy region. It will bring together young people from Poland, Italy, Georgia and Ukraine to conduct interactive charity theatre performance for orphan children with hearing impairments.
The deadline for submitting your application form is 25 November 2017.
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Email *
Name and Last Name *
Sex *
Date of birth *
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Country *
Home address (city, zip code, street, house, apartment) *
Cell phone *
(including country code)
E-mail *
Facebook account *
Do you have any special needs or requirements that the host organisation should know about? *
E.g. mobility, medical needs, allergies, dietary restrictions, smoker/non-smoker etc.
Person to be contacted in case of emergency *
Name, phone number, email address
How do you assess your level of English? *
Have you participated in any international projects before? *
If yes, please write which ones.
Why do you want to take part in the International Youth Exchange? *
How can you contribute to the learning process in the "Nikolas' Helpers"? *
How do you understand what is active citizenship? *
How you are going to use the acquired experience in your local community? *
Anything else you would like to add to let us know?
I am giving the permission for personal data use in the frames of the project. I am responsible for the validity of the given information. By marking "YES", I confirm my participation in YE "Nikolas' Helpers". *
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