PARTICIPANTAPPLICATIONFORM

TRAININGCOURSE

StayHealthierOutside
0714NOVEMBER2016
Bari,Italy

ProjecthostedbySOFunderErasmus+programme

PartI

A.Personaldetails
Nameandsurname:
Gender(Male/Female):
Dateofbirth:
Profession/occupation:
Cityandcountryofresidence:
Specialneeds(e.g.food,disability,
others,pleasespecify):

B.Contactdetails
Address:
Email:
Mobiletelephone:
Facebook/Twitterlink:

PartII
Whatisyourpersonal/professionalexperienceinrelationtothethemeofthe
project?

WhatpreviousCouncilofEurope,YouthinAction,Erasmus+oranyother
internationalyouthactivitieshaveyouattended?Pleasespecifythenameand
thedatesoftheactivities.

Whatisyourmotivationtoattendthisexperience?

Pleasewriteyourpossibletravelitinerary

Country:
Travellingfrom(nameofcity):

Dateandtimeofarrival:
Airline:
Arrivalairport:
Departuretime(flight):
Departuretimepoint(trainstation/bus
station):

Notes:

Submittoyoursendingorganization.
Participatingorganisationandcontacts
SOFITALY,ITALY(APPLICANT)
sofngo@gmail.com

INTERNATIONAL CENTER FOR PEACE AND INTEGRATION (ICPI), GEORGIA

(PROJECTCOORDINATOR)
khatuna_chaladze@yahoo.com

aphilauri@yahoo.com
gocha1gelashvili@gmail.com
FUNDACJAINICJATYWSPOLECZNYCH,POLAND
gajdzinska.m@gmail.com
ASOCIATIATINERILORACTIVICIVIC,ROMANIA
atac.romania2010@gmail.comlaurpetrea@gmail.com

"YOUTHBREATH"YOUTHSUPPORTNGO,ARMENIA
anijanyan@gmail.com
ULUSLARARASIGENCLIKDERNEGI,TURKEY
fatihgokyildiz34@gmail.comuluslararasigenclikder@gmail.com
NONGOVERNMENTORGANIZATION"UNIT",UKRAINE
helen.manko@gmail.com
WORLDYOUTHALLIANCEMIDDLEEAST,LEBANON
jessica@wya.net