Mobility of youth workers - Partner Countries

Application Form
-PolandPERSONAL INFORMATION
Name and surname
Home address

Date of birth
Gender
Nationality
Email
Mobile telephone

PASSPORT /ID DETAILS

Passport/ID number
Issued by (place)
Do you need a visa to travel to Poland?

Issue Date
Expiry Date
YES

EMERGENCY CONTACT DETAILS

Name and surname
Relationship to you

Telephone number
E-mail

SPECIAL REQUIREMENTS
Dietary requirements (e.g. vegetarian,
gluten free, halal, etc.)
Mobility issues
Other

Medical conditions

ADDITIONAL INFORMATION FOR THE ISSUING OF YOUTH PASS RECOGNITION

Place of birth (town)
Country of
residence

Country of birth
Your name as you
would like it to
appear on your
certificate

NO

ORGANISATION DETAILS
Name of organisation
Organisation address

Contact person

Group of the European Youth for Change

(To be completed
Your role in the
by GEYC)
organisation
Website
Email
Telephone number
Ana Maria LULEA

ORGANISATION SHORT DESCRIPTION

1 What do you do in your organisation
2 Your international youth work experience
including Youth in Action
APPLICATION QUESTIONS
...ABOUT THE COURSE
What is your motivation for applying to
this project?
What positive contributions will you make
to the group/week?
What do you expect to take away from
this training course in terms of learning?
Please explain how this training course
may help you and your organisation in
the future.
... ABOUT YOUR LANGUAGES
What is your mother tongue?
How many languages do you speak?
Please specify.

Contact person
e-mail

www.geyc.ro
office@geyc.ro
(To be completed by
GEYC)
anamaria.lulea@geyc.ro

Where would you place yourself Looking

at the Common European Framework
(CEF):
http://www.wlv.ac.uk/pdf/lssc_wlp_cefr.
pdf
Do you use your mother tongue to
communicate on a daily basis, if not, what
language(s) do you use?
What is the most difficult thing for you
when communicating in English to native
speakers and non-native speakers of
English?
... ABOUT YOU PERSONALLY
If you have the power to make changes
in your country, what is the first 3 things
you will change?
What is the most interesting place you
have visited and why?
Who is the most inspiring person for you
and how did he/she influenced your life?

... AND FINALLY

What makes you a good participant for
this training course?
Are you a member of GEYC Community?
Facebook profile:
(link)

Deadline for sending the application: 14 May 2015

To whom: anamaria.lulea@geyc.ro, subject [TC-Poland]
By 23th of May: selection of participants, notifications and confirmations (paying the participation
fee - please notice that the participation fee is non-reimbursable).
Note: if you won't receive an e-mail by 23th of May, it means that we found other suitable
candidates for this project.
Good luck!