Application form Train your Disconnection
Dear applicant, by filling in this form you are applying for the training course  "Train your disconnection" that will happen from the 3rd till the 10th of June 2019 in Bergolo, Italy.

By filling this form you declare that you have fully read and understood the content and the conditions of the webpage of the project: http://bit.ly/train_your_disconnection


With your application, you commit yourself for the whole project: preparation, participation in training course and follow-up activities.

We will choose as participants the applicants that will look to us more in line with the aim and method of the project, we recommend you to dedicate enough time and care to complete it fully.

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Country of residence: *
First name: *
Surname *
Name you want to be called during the training : *
It will be printed on your name tag
Date of birth: *
MM
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DD
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YYYY
Nationality *
How do you identify yourself concerning your gender? *
Address of residence 1 *
street/square name and number
Address of residence 2 *
ZIP code and city
Email contact: *
We will communicate with you through this contact
Mobile number *
national prefix + number
What is your current occupation or profession? *
What is your level of English? *
Do you have any physical limitation? *
If yes explain what it is and how it is limiting you (what you can do and what you can't do because of it).
Do you have any diet or allergy? *
ex. vegan, vegetarian, lactose free, gluten free, allergy to cheese, allergy to bees' bites...
Do you take any regular medication? *
If yes explain what medication
Do you have a medical insurance valid in Italy? *
ex. the European Health Card
Contact in case of emergency *
Write the name, surname, phone number and what relation this person has with you
Did/do you face any obstacle/difficulty related with your social environment, culture, identity, family, economic situation or do you live in an isolated place? Do you have chronic health problems? *
Explain briefly
Is the contribution of 50€ a real obstacle for you to participate in this project? If yes explain why *
What is that calls you to apply for this project? Why do you want to participate? *
What is your experience in working with young people? *
Within the time frame 12th June - 30th September 2019, will you be able to implement a group activity with young people in connection with the topics and goals of "Train your disconnection" or to report what you learned within your organization through a presentation activity? *
What is the impact that the use of social medias has in your life? *
What is your connection with technologies? *
How many hours do you use social media in your daily routine? *
What do you want to improve or learn during Train your Disconnection? *
Be specific: it support us to understand your expectations and it support yourself in approaching the project with a pro-active attitude and fulfill those expectations (a training course is an active experience, don't come only as a receiver!)
Which of your talents/knowledges regarding the main topics of the project  could you share with the other participants? *
How do you plan to use what you learn in the project when you go back home? *
Have you participated in any project supported by Erasmus+ before? *
(e.g. Youth Exchanges, Training Courses, EVS, ect.)
How did you find out about this project? *
Facebook of a friend/sending organization on a youth mobility portal, in a youth center, friends, someone recommended it to me etc.
Is there anything else that you want to add? (optional)
*
I hereby declare that all the above information are true and correct to the best of my knowledge. By submitting this application I confirm that I have read and understood the information written in the webpage of the project: http://bit.ly/train_your_disconnection and the conditions of reimbursement of train your disconnection project and I know and accept the conditions of participation. I commit myself to take part for the full duration of the project: preparation, training course and follow-up activities and to participate in the whole evaluation process; in case I will break this commitment I will renounce to the travel reimbursement. I am aware that obtaining a health and a full travel insurance is my own initiative and at my own expenses. I understand that the information I provided on my special needs does not remove my own personal responsibility for ensuring my own health. I understand and agree that the project may be photographed/filmed and used for publications or websites and social networks to provide visibility to the project, the organizations and the public bodies involved in it.
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