Please complete this form in English. The information present in this form will help the educational team understand more about your training needs and expectations and also make sure you need this training course, so please be as exhaustive as possible!




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НазваPlease complete this form in English. The information present in this form will help the educational team understand more about your training needs and expectations and also make sure you need this training course, so please be as exhaustive as possible!
Дата конвертації04.01.2014
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Pandora’s box

Training course

20 / 28 January 2013

Ukraine, Kiev





APPLICATION FORM
Please complete this form in English. The information present in this form will help the educational team understand more about your training needs and expectations and also make sure you need this training course, so please be as exhaustive as possible!


PERSONAL DATA



Name and current address of the participant

Family name




First name




Street address




Postcode




City




Region




Country




Telephone




Email







^ Personal details

Date of birth




Gender

 female

 male

Country










^ Special needs

Do you have any special needs (dietary needs, mobility problems, health care, etc.)?





^ Emergency contact

Please provide contact details of a person who can be contacted in case of an emergency.

Family name (Mr/Ms)




First name




Street address




Postcode




City




Region




Country




Telephone




Email







^ Language Abilities (Spoken)

1. English

 poor

 good

 very good

 excellent

2. Other

 poor

 good

 very good

 excellent


ORGANISATION



^ Details of the organisation

Name




Street address




Postcode




City/country




Region







Email




Website




Telephone




Telefax




^ Profile of the organisation

Please give a short description of your organisation (regular activities, target group, member of, etc.):







What is your role in the organisation?







^ EXPERIENCE & MOTIVATION




Previous experience

^ Please describe your experience in the youth field







Motivation

^ Why would you like to participate in this course?







Learning needs

^ The TC is build on the participants learning and training needs. Please tell us what whould you like to learn and/or practice during the TC?






Results

^ How do you think to put into practice all that you´ll learn during the course?







Comments

Do you have any other comments as far as the Training Course is concerned?






DECLARATION



I also accept to pay 30 euros as participation fee and 30% of my travel cost.

Name:
Place and Date:


Please return this application form to:
[tcpandorabox@gmail.com]
Before the 23d of December 2013

THANK YOU!!!

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