Application form


With the support of the Erasmus+ programme of the European Union
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Email *
Please specify the name of the project that you are interested in... *
Required
Surname *
(Family name)
Name *
Gender *
Required
Birth Date *
MM
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DD
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YYYY
Nationality *
Place of Birth (city & country) *
Residence country *
Identity documents *
Please insert your identity document number (ex: Passport nr. 123456 or ID Card nr. 123456)
Mobile Phone *
Please insert the international code
E-mail address *
Facebook account *
Give us the link to your facebook profile (ex. www.facebook.com/InitiativeSocialeAssociation)
Emergency contact *
Name and phone number
EDUCATION
Are you studying/ Did you study at the university? *
Required
If yes, indicate in which one & what did you/are you study/ing: *
CURRENT SITUATION
What is your status on  the labor market ? *
Required
Belonging to a vulnerable group *
Do you belong to a group with any fewer opportunities listed below? If so, please check:
Required
MISCELLIOUS
Do you have medical problems / disabilities ? *
If yes, please specify!
Do you need special medication ? *
 If yes, please specify!
Do you have any allergy ? *
If yes, please specify! (ex: milk, products made of milk, grass etc.)
Do you have dietary restrictions ? *
If yes, please specify! (ex.: vegetarian, vegan, no pork etc.)
Do you have a valid Passport ? *
Is your Passport available for 6 more months from mobility starting date ?
Required
Do you need an Invitation letter from us or from the hosting organisation? *
Required
Language Proficiency *
Please indicate your level of spoken English
Poor
Very well
INVOLVEMENT IN YOUTH WORK
Have you participated in any international activity ? *
If yes, please specify!
Have you participated in any other activities within the "Erasmus+" Programme? *
If yes, please specify!
Please describe your previous youth work experiences! *
Explain your role in your NGO (or your role into the sending organisation)... *
MOTIVATION & EXPECTATIONS
Please describe your personal motivation to attend this activity *
Please describe how can you contribute to this activity *
What are your expectations from this activity? *
How do you think that you will use the gained experience? *
NEEDS
Do you smoke ? *
Required
Do you have any special skills (for example: acting, painting, writing) ? *
 If yes, please specify!
What is your T-shirt size ? *
for example: S, M, L, XL etc.!
Required
Do you want to have fun in this project ?   *
Required
Do you want a Youthpass Certificate for this project ? *
Required
OTHER INFORMATION
If you would like to add anything please write here:
How did you find out about this project and about us ? *
TRAVEL DETAILS
Please describe your full itinerary (including arrival and departure to/from project venue), your means of transport and your approximately costs. *
Estimated travel costs *
Expected Arrival time *
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Time
:
Expected Departure time *
MM
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DD
/
YYYY
Time
:
Statement
Please take note of the following conditions that will apply in this exchange: 1. I hereby declare that I read the project Infopack and I'm aware about all the informations written in it. 2. I commit myself to participate in the whole process, including: • to prepare myself carefully for the activity • to take part in the full duration of the activity • to participate in the whole evaluation process and follow-up event. 3. I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expenses. 4.  I commit myself to bring all original travel documents and financial statements (invoices, e-tickets, proofs of payment, boarding passes and/or other bus/train tickets) otherwise I am aware that the reimbursement will not be possible until I will provide all required documents. 5. I understand that the information I provided on my special needs does not remove my own personal responsibility for ensuring my own health. 6. I authorise Romanian National Agency, the European Commission, the Hosting Organisation and the Sending Organisation to publish, in whatever form and by whatever medium, including the Internet, my correspondence address, information about my organisation, work and pictures taken at the exchange. 7. I agree to the use and dissemination of my image exclusively for the purpose of the project. I grant full rights to take material (photography/ video filming) & use it, and any reproductions or adaptations of the material for the promotion of this project, employability and/ or European opportunities for young people. [This might include (but is not limited to), the right to use them in our printed and online promotion, social media, press releases and final report]. 8. I hereby declare that the above information are true and I agree that AIS staff to process it.   *
Required
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