Empowering youth - Strengthening communities Application Form.

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* 1. Country and Name of partner organization:

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* 2. First Name

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* 3. Last Name

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* 4. Full address

Street

City

Zip Code

Country

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* 5. Let us know your T-Shirt SIZE (Small, Medium, Large, XLarge)

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* 6. Date of birth and Gender

Date of birth (ex. 3 January 1995)

Gender (Male or Female)

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* 7. Contact

Mobile phone number (ex. 0034635891362)

Facebook ID or link

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* 8. Health

Special diet if any (ex: vegetarian)

Specify if you take currently any medication or have taken within the last 2 months

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* 9. Contact person in case of emergency

Full Name

Mobile phone no.

Relationship to you

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* 10. Level of English

Poor

Medium

Good

Very good

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* 11. Why are you interested in this training?

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* 12. How does the theme of this training relate to your life or work?

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* 13. What skills or competences do you want to practice and develop?

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* 14. What results do you expect concerning your personal development? What about on professional level?

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* 15. What do you want to learn concerning the themes of the training?

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* 16. Questions, remarks, anything else you want to add:

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* 17. By submitting this application I, the undersigned, confirm that I have read and understood the Information Letter and the conditions of reimbursement about the Empowering youth - Strengthening communities Training course and I know and accept the conditions of participation.

Date of signature

Signature (type your name)