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Learner application form - LIFELONG LEARNING PROGRAMME GRUNDTVIG WORKSHOPS
Please fill this application form.
If your candidature to this Workshop is accepted, the Workshop Organiser will inform you about the selection on the next day at the latest.
PLEASE NOTE, online application form cannot be saved for later editing.
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Identification of the Workshop
Title of the workshop: Discover Yourself, Discover Europe
Host institution: Association Kūrybinės raiškos centras
Dates of the Workshop: from 14/07/2012 to 22/07/2012
Identification of the candidate learner
Title
*
Choose
Mr
Ms
First Name
*
Your answer
Family Name
*
Your answer
Address
*
Your answer
Postcode
*
Your answer
City
*
Your answer
Country
*
Your answer
Telephone 1
*
Including country and area codes
Your answer
Telephone 2
Including country and area codes
Your answer
Mobile
Including country and area codes
Your answer
Fax
Including country and area codes
Your answer
E-mail address
*
Your answer
Date of birth
*
Your answer
Nationality
*
Your answer
Occupation (if applicable)
*
If retired / unemployed: what former job did you do?
Your answer
Language(s) abilities:
Please mention all languages in which you are able to work and indicate your level for each of it
(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)
English
*
(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)
Basic
Good
Very Good
Fluent
Mother Tongue
Listening
Speaking
Reading
Writing
Basic
Good
Very Good
Fluent
Mother Tongue
Listening
Speaking
Reading
Writing
Other languages
Please specify level for each
Your answer
Please provide answers to the folliwing questions
Have you participated in Grundtvig WS before?
*
Choose
Yes
No
Do you have any special needs?
(E.g. mobility, medical needs, allergies, dietary restrictions)
Your answer
Experience with former international activities
*
Your answer
What is the relation between your personal interests/passions and main themes of the workshop (environment, experiental learning, photograpfy)?
*
Max. 200 words
Your answer
What do you expect to gain from this workshop?
*
Max. 200 words
Your answer
Why should you be selected for this workshop?
*
Max. 200 words
Your answer
Are you comfortable with sharing rooms for 2 or 3 people?
*
Your answer
Are you willing to try out scuba diving during the workshop?
*
Your answer
PLEASE NOTE: participants willing to experience scuba diving as a part of the programme of this workshop must check the medical forms(please see InfoPack)
If you have doubts about any of the illnesses mentioned in the list, you have to visit your doctor for health reasons and get signed approval.
Other information you would like to mention
*
Your answer
Please check the box if appropriate:
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I am resident in one of the EU 27 member states or Norway, Lichtenstein, Iceland, Croatia, Switzerland, Turkey
Required
*
I am able to participate in the full duration of the workshop
Required
*
I am fully responsible for my own health condition, able to travel and participate in the activities of the workshop
Required
*
If selected, I will inform organisers about any changes of my availability to participate as soon as possible
Required
*
I agree to sign medical forms attached about my health, needed for scuba diving and other methods, used in this workshop
Required
*
I can cover my own travel costs at the beginning and wait up to 30 days after the workshop to receive 100% reimbursement of the travel costs
Required
If you would have any clarifications you feel free to call project coordinator Laimonas Ragauskas by phone +370-657-94041 or Agnė Rapalaitė by phone +37064128345 or write e-mail to
workshop@krc.lt
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