Training Course \"The Map of \" icon

Training Course "The Map of "




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1. /Приложение 1_Description of the project.doc
2. /Приложение 2_application form training-Ukraine.doc
Ukraine, 15 21 of May 2009
Training Course "The Map of "







APPLICATION FORM PARTICIPANTS


Training Course “The Map of “European citizenship”

15.05.2009 - 21.05.2009

Donetsk, Ukraine


Personal data:


Full name of applicant :

Nationality :

Date of birth :

Sex (underline) : Male / Female

Private address :

Postal Code :

Phone :


Fax :

E-mail :


Name and address of the organization/institution/authority which supports you:



Organization name :

Address :

Postal Code :

Phone :

Fax :

E-mail :


Organization general aims:


Organization main projects/activities in 2007/2008:


What is your position and job in your organization:


Do you have a mandate from your organisation in order to make concrete agreements with other organisations?


YES NO


Have you participated in similar events? When? Where?


What are your expectations about the training:


How will this event benefit you and your organization:


How will you be able to spread training results e.g. placement information about the training in local mass media, presentation among the target group of your organisation etc.:


In case you need a visa for entering Ukraine, please write your personal data:


NO VISA IS NEEDED


Surname :

name :

Date of birth :

Sex :

Nationality :

Place of birth and region :

State and region of  staying :

Passport number :

Date of issue  :
Date of expiry :


Name of the organization :

Address of the organization :


Special needs (some assistance, vegetarian food etc.)


Non-smoker

( ) vegetarian

( ) special diet – (please specify):

( ) other remarks concerning meals (for example for religious reasons):


Working languages are English and Russian:


English ( ) fluent ( ) good ( ) basic


Russian ( ) fluent ( ) good ( ) basic


Travelling:


Please, explore and mention the cheapest mean of transport and travel costs from your location to Donetsk, Ukraine and back (student fare, APEX tickets, etc)


The cheapest mean of transport and travel costs from your location to Donetsk


Means of transport (underline) : airplane - bus - train


Estimated price (in Euro) :


Expected arrival time :


Expected departure time :


Name and full contact details of next-of-kin to be contacted in case of emergency:


Name :

Address :


Postal Code :


Phone :


E-mail :


Please take note of the following conditions that will apply if you are selected to take part in the training course.

  1. I commit myself to participate in the whole process, including:

  • to prepare myself carefully for the training course and to do all remote preparation work the team will ask for,

  • to take part in the full duration of the training course,

  • to participate in the whole evaluation process,

  1. I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expenses. I understand that the information I provided on my special needs does not remove my own personal responsibility for ensuring my own health.

  2. I authorise the European Commission to publish, in whatever form and by whatever medium, including the Internet, my correspondence address, information about my organisation and work as well as pictures taken at the course.



Signature of applicant


Date: Place: Signature:


All applicants must apply by filling in the relevant application form and sending it back by 28 of March.

Contact address

EURC “Social Partnership”

Illicha ave.79/31, Donetsk-83003, Ukraine

phone: +3 8 050 654 56 21, fax: + 3 8 062 385 98 39


e-mail: olena_2006@yahoo.com

URL: www.ngo.dn.ua


Application form Training Course “The Map of “European citizenship”




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