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CANDIDATESAPPLICATIONFORM
Read carefully before answering. Use print letters.
Space to be filled out only by the Sending Committee
COUNTRIES From To
PERIOD From To
Last Name Female
FirstName S Male
Personal Address
Telephone (+ ) - Email
Date of Birth (D/M/Y) Place of Birth
Nationality Passport Number
Date of issue : Expiry date:
Marital Status Religion
_________________________
Person to contact in case of emergency (name, address, telephone, e-mail).
Please give details of your academic background and any previous or current work experience.
What is your mother tongue? Doyouspeakanyforeignlanguages?
Language Yearsstudied Fluent Good Fair Basic
What are your hobbies?
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Please describe yourself, including your strengths and weaknesses.
Have you had any international experiences (for example: camps and conferences in other countries,
contact with people of other cultures, etc.) ? If so, please give details.
Have you been involved in any organisations, movements, service programmes and other projects? If
so, please give details.
What are your main reasons for going abroad ?
What skills do you have ?
Working with children/youth Manual skills (please specify)
Working with disabled Teaching
Animation Sports
Computers Music
Others, please specify
What do you hope to gain from and achieve during the exchange programme ?
What challenges do you think you will encounter during your experience ?
Do you have any objections to sharing a room ? Yes No
If your answer is yes, please explain why.
Do you smoke ? Yes No
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Do you have special dietary requirements ? Please indicate.
No Vegetarian
Other
Do you have any allergies? Yes No
If your answer is yes, please indicate what kind.
Do you have any medical/health issues that may affect your participation in the programme? Please
include all details of any existing medical condition, of any medication you are currently taking and of
any hospital treatment received in the past year.
Date _____________________ Signature of Candidate __________________________________
Please feel free to complement this form providing additional information on a separate sheet of paper.
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