LET’S BECOME YOUNG EUROPEAN CITIZENS IN SICILY! EUROPEAN CITIZENSHIP YOUTH EXCHANGE BIANCAVILLA, SICILY, ITALY 01.09.2010 – 08.09.2010 DÍNAMO + VEDOGIOVANE
PARTICIPANT APPLICATION PERSONAL DATA FULL NAME : NATIONALITY: BIRTHDAY: SEX: HOME ADRESS: MOBILE PHONE: E-MAIL: EMERGENCY NUMBER/PERSON OF CONTACT: ARE YOU ALREADY A DÍNAMO ASSOCIATE? IF NOT, WOULD YOU LIKE TO BECOME?
MALE:
FEMALE:
(TO BE AN ASSOCIATE OF DÍNAMO IS
MANDATORY FOR PARTICIPATING ON THIS PROJECT)
SPECIAL NEEDS/LANGUAGE SKILLS SMOKER : YES: FOOD: NO SPECIAL VEGETARIAN: REQUIREMENTS:
NO: OTHER (PLEASE DESCRIBE):
LET’S BECOME YOUNG EUROPEAN CITIZENS IN SICILY | BIANCAVILLA, SICILY, ITALY, 2010 | PARTICIPANTS APPLICATION MEDICAL/PHYSICAL SPECIAL NOTHING CONDITION (INCLUDING RELEVANT: ALLERGIES, MEDICAL INTOLERANCES, DISEASES, HANDICAPS, ETC.): LEVEL OF ENGLISH: (1) BASIC:
YES (PLEASE REFER MEDICAL/PHYSICAL STORY AND SPECIAL ASSISTANCE AND/OR MEDICATION NEEDS, OR OTHER):
(2) MEDIUM:
(3) GOOD:
(4) VERY GOOD:
(5) MOTHERTONGUE:
OTHER SPECIAL NEEDS:
PERSONAL BACKGROUND, EXPECTATIONS & MOTIVATION (OR THE 10 IMPORTANT SHORT QUESTIONS) PLEASE DESCRIBE YOUR ACTIVE CITIZENSHIP PREVIOUS EXPERIENCE. (10 LINES MAX.)
ARE YOUR CURRENTLY
STUDYING? WHAT? AND IN
WHICH YEAR?
(10 LINES MAX.)
WHAT DO YOU THINK EUROPEAN CITIZENSHIP IS? (10 LINES MAX.) WHY DO YOU WANT TO PARTICIPATE ON THIS PROJECT? HOW WOULD YOU CONTRIBUTE TO IT? (10 LINES MAX.) WHAT WOULD YOU LIKE TO FIND DURING THIS EXCHANGE PROCESS, ONCE IN KRAKOW? (10 LINES MAX.) WHAT WOULD YOU LIKE NOT TO FIND DURING THIS EXCHANGE PROCESS, ONCE IN KRAKOW? (10 LINES MAX.) DID YOU ALREADY HAVE BEEN INVOLVED IN ANY DINAMO’S ACTIVITY(IES)/EVENT(S)? WHAT WAS YOUR ROLE? (10 LINES MAX.) HOW WOULD YOU DESCRIBE YOURSELF? (YOU CAN USE WORDS, IMAGES, LINKS FOR MOVIES OR MUSICS, ETC.) (10 LINES MAX.) WHAT IS ON YOUR MIND RIGHT NOW? (10 LINES MAX.)
SIGNATURES DATE: PARTICIPANT SIGNATURE:
PLACE: PARTICIPANT EDUCATION RESPONSIBLE SIGNATURE: ONLY COMPLETELY FILLED APPLICATIONS WILL BE ACCEPTED!!!
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