Application form for participants Project E(urope) U(nited) Leaders Struga, Macedonia 0 !0"! 0#$ #0!0"!

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GENERAL INFORMATION Surname: Date of birth: Name: Place of birth: Gender: Age (years old):

Your contact address (where you can be reached for all questions concerning the e ent): Street and number: Post code: "ountry: !ele$hone: !own: #egion: %a& number:

'(mail: Do you have any special needs? (Please indicate any health alle!"ies# dieta!y details$ Please as well $ro ide details for your emergency contact: ORGANI%ATIONAL &A'(GRO)ND Name of your sending organisation: Do you ha e any $ersonal e&$erience with Youth in Action $ro)ects* +f yes, $lease mention $ast $ro)ect you ha e $artici$ated---

.hat is your le el of /nowledge of Action 0-1 ("oo$eration with the Neighboring countries of the 'uro$ean 2nion)* Please select: low medium high 3nowledge of 4anguages: ($lease indicate)

*ith the suppo!t o+ the ,O)T- IN A'TION P!o"!a..e o+ the Eu!opean )nion

'nglish: 5ther:

ery good

good

sufficient

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MOTI/ATION AND E0PE'TATION .hy do you want to $artici$ate in this youth e&change* .hat do you e&$ect to gain $rofessionally and $ersonally from it* .hat is your moti ation* Please elaborate-

.hat do you thin/ will be your contribution to the success of the $ro)ect* .hat can you offer to the $rogramme *

Please indicate anything else you would li/e to share about your wor/, res$onsibility, s/ills, e&$eriences---

Place and date1 Na.e o+ applicant1 Na.e and su!na.e o+ the !esponsi2le pe!son in the o!"anisation1 Please !etu!n the co.pleted application +o!. latest 2y 34th o+ Ap!il 3564 (2y e.ail$ to1 7ate8di.ovs7a9yahoo#co. T-AN( ,O) ::::

*ith the suppo!t o+ the ,O)T- IN A'TION P!o"!a..e o+ the Eu!opean )nion