Youth Exchange COLOR BLIND - Application form

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Scambio Giovanile internazionale a Ludberg (Croatia)
3-11 Luglio 2019

ATTENZIONE! Il modulo può essere compilato anche in lingua italiana

First Name *

as on your passport

Family Name *

Surname as on your passport

Nationality *

Date of birth *

YYYY

Gender *

Complete home address *

Postal code *

Town *

Country *

Phone (preferably mobile) *

with full international dial codes

Email *

Language(s) abilities

Please mention all languages in which you are able to work and indicate your level for each of it.

English *

(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)

Basic

Mother Tongue

Language 2

Please specify

(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)

Basic

Mother Tongue

Clear selection

Language 3

Please specify

(1-basic, 2-good, 3-very good, 4-fluent, 5-mother tongue)

Basic

Mother Tongue

Clear selection

Do you have any special needs or requirements that the host organisation should know about?

E.g. mobility, medical needs, allergies, dietary restrictions (vegetarian, vegan, etc.), smoker/non-smoker

Clear form

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