LET’S BECOME YOUNG EUROPEAN CITIZENS IN SICILY!

EUROPEAN CITIZENSHIPYOUTH EXCHANGE

BIANCAVILLA, SICILY, ITALY01.09.2010 – 08.09.2010

DÍNAMO + VEDOGIOVANE

PARTICIPANT APPLICATION

PERSONAL DATAFULL NAME :

NATIONALITY:BIRTHDAY:

SEX: MALE: FEMALE: HOME ADRESS:

MOBILE PHONE:E-MAIL:

EMERGENCY NUMBER/PERSON OF CONTACT:

ARE YOU ALREADY A DÍNAMO ASSOCIATE? IF NOT, WOULD YOU

LIKE TO BECOME?(TO BE AN ASSOCIATE OF DÍNAMO IS

MANDATORY FOR PARTICIPATING ON THIS PROJECT)

SPECIAL NEEDS/LANGUAGE SKILLSSMOKER : YES: NO:

FOOD: NO SPECIAL REQUIREMENTS:

VEGETARIAN: OTHER (PLEASE DESCRIBE):

MEDICAL/PHYSICAL SPECIAL CONDITION (INCLUDING

ALLERGIES, MEDICAL

NOTHING RELEVANT:

YES (PLEASE REFER MEDICAL/PHYSICAL STORY AND SPECIAL ASSISTANCE AND/OR MEDICATION NEEDS, OR OTHER):

LET’S BECOME YOUNG EUROPEAN CITIZENS IN SICILY | BIANCAVILLA, SICILY, ITALY, 2010 | PARTICIPANTS APPLICATION

INTOLERANCES, DISEASES, HANDICAPS, ETC.):LEVEL OF ENGLISH: (1) BASIC: (2) MEDIUM: (3) GOOD: (4) VERY

GOOD: (5) MOTHER-TONGUE:

OTHER SPECIAL NEEDS:

PERSONAL BACKGROUND, EXPECTATIONS & MOTIVATION (OR THE 10 IMPORTANT SHORT QUESTIONS)PLEASE DESCRIBE YOUR ACTIVE

CITIZENSHIP PREVIOUS EXPERIENCE.

(10 LINES MAX.)ARE YOUR CURRENTLY

STUDYING? WHAT? AND IN WHICH YEAR?

(10 LINES MAX.)WHAT DO YOU THINK EUROPEAN CITIZENSHIP IS? (10 LINES MAX.)

WHY DO YOU WANT TO PARTICIPATE ON THIS PROJECT? HOW WOULD YOU CONTRIBUTE

TO IT?(10 LINES MAX.)

WHAT WOULD YOU LIKE TO FIND DURING THIS EXCHANGE

PROCESS, ONCE IN KRAKOW?(10 LINES MAX.)

WHAT WOULD YOU LIKE NOT TO FIND DURING THIS EXCHANGE PROCESS, ONCE IN KRAKOW?

(10 LINES MAX.)DID YOU ALREADY HAVE BEEN

INVOLVED IN ANY DINAMO’S ACTIVITY(IES)/EVENT(S)? WHAT

WAS YOUR ROLE? (10 LINES MAX.)

HOW WOULD YOU DESCRIBE YOURSELF? (YOU CAN USE

WORDS, IMAGES, LINKS FOR MOVIES OR MUSICS, ETC.)

(10 LINES MAX.)WHAT IS ON YOUR MIND RIGHT

NOW?(10 LINES MAX.)

SIGNATURESDATE: PLACE:

PARTICIPANT SIGNATURE: PARTICIPANT EDUCATION RESPONSIBLE SIGNATURE:

ONLY COMPLETELY FILLED APPLICATIONS WILL BE ACCEPTED!!!

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