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Camp of Democracy and Multiculturalism
Erasmus+: Youth, Key Action 1: Youth Exchange
Venue: Adana, Turkey
Youth Exchange dates: 2—11 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
If you answered "other" in the above 'Citizenship' section, 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
*
Your answer
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
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
Emergency contact (name & surname, email address, phone number and relationship to you - e.g., mother):
*
Your answer
Will you have received a Covid-19 vaccination by the start of this project?
*
Yes, I will have a valid Covid-19 certicate at the time of this project. It will be fewer than 180 days since my 2nd vaccine
I do not intend to get vaccinated
I have recovered from Covid-19 in the past 180 prior to the project end and I have a valid certicate proving so.
I have already received my 3rd/booster dose
Other:
How/where exactly did you find out about this Erasmus+ project?
*
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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