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Our Values, Our Europe
Erasmus+: Youth, Key Action 1: Youth Exchange
Venue: Varna, Bulgaria
Youth Exchange dates: 16—23 September 2022
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APPLICANT INFORMATION
Name
*
Your answer
Surname
*
Your answer
Gender
*
Choose
Female
Male
Date of birth
*
MM
/
DD
/
YYYY
Age at the time of the project:
*
Your answer
Citizenship
*
Choose
Czech
Slovak (and I live in Slovakia)
Slovak (and I live in the Czech Republic)
Other and I do have a valid residency permit in the Czech Republic
Other and I do NOT have a valid residency permit in the Czech Republic
I am a Ukrainian citizen and I have been granted temporary protection in the Czech Republic
ONLY IF you answered "other" in the above 'Citizenship' section, then please state your citizenship/nationality:
Your answer
Full address
*
Your answer
Current country of residence
*
Your answer
Region:
*
Choose
Hl. město Praha
Středočeský
Jihočeský
Plzeňský
Karlovarský
Ústecký
Liberecký
Královéhradecký
Pardubický
Kraj Vysočina
Jihomoravský
Olomoucký
Moravskoslezký
Zlínský
Not applicable, I do not live in the Czech Republic
Email address
*
Your answer
Mobile phone number
*
Your answer
Link to your social media profile (FB/IG)
*
Your answer
Please let us know your vaccination status against Covid-19 will be by the the start of this training course:
*
I will hold a valid Covid-19 certificate at the time of this project. I will be fully vaccinated with a two-dose vaccine. Fewer than 180 days passed since my 2nd vaccination and the start of this project
I will be fully vaccinated with a single-dose vaccine (Johnson&Johnson). Fewer than 180 days passed since my vaccination and the start of this project
I will NOT have a valid Covid-19 certificate. I was vaccinated in the past but more than 180 days passed since my vaccination and the start of this project.
I do not intend to be vaccinated
I have recovered from Covid-19 disease (and I have a certificate proving so). It will have been fewer than 180 days since my first positive Covid-19 PCR test and the end of this project. I will hold a valid Covid-19 certificate at the start of this project.
I will have received my booster/3rd dose by the start of this project. I will have a valid Covid-19 certificate for the duration of this project.
Other:
Does any of these apply to you? *We wish to give equal opportunities to everyone. If you face any obstacles, please indicate, so we can also ensure diversity in our group.
*
You face geographical obstacles: You live in rural area (countryside), dangerous area in city or in any other way face geographical obstacles
You face cultural differences: You are minority, immigrant/refugee or descendant from immigrant or refugee families. This includes young people belonging to a national/ethnic minority.
You face economic obstacles: You are unemployed or struggle with your finances (low income). You may be dependent on social welfare system.
You are not in education/employment or training (NEET)
You have a disability/special needs: you are a young person with mental (intellectual, cognitive, learning), physical, sensory or other disabilities
You have a health problem: you are a young person with chronic health problems, severe illnesses or psychiatric conditions
You face social obstacles: You are a young person facing discrimination because of gender, age, ethnicity, religion, sexual orientation, disability, etc.
You face educational difficulties: You may be a young person with learning difficulties, an early school leaver, a young person with poor school performance
None of the above
Other:
Required
Passport expiry date (if you do not own a passport, please do NOT apply for this project)
*
MM
/
DD
/
YYYY
Do you have any special needs or requirements that the host organization should know about? (E.g.mobility, medical needs, allergies, dietary restrictions such as vegan)
*
Your answer
Language abilities in English
*
A1 (Beginner)
A2 (Elementary)
B1 (Intermediate)
B2 (Upper-Intermediate)
C1 (Advanced)
C2 (Proficiency)
Listening
Speaking
Reading
Writing
A1 (Beginner)
A2 (Elementary)
B1 (Intermediate)
B2 (Upper-Intermediate)
C1 (Advanced)
C2 (Proficiency)
Listening
Speaking
Reading
Writing
ORGANIZATION INFORMATION: Please tell us about your ORGANIZATION, i.e., the (non-profit non-governmental) organization that you actively work/volunteer for, IF ANY). Please leave BLANK (empty) if you are NOT active in any non-profit non-governmental body]:
Name of organization
Your answer
Address
Your answer
Website
Your answer
What are your roles (volunteer, youth worker, board member, director ...) and your tasks? Please tell us how long you have been involved in youth work?
Your answer
Please describe your organization briefly. What are the objectives, main activities and target group of your organization?
Your answer
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