AC

DR
AFRICAN CENTRE FOR
DEVELOPMENT &RESEARCH

MEDIA PRISM YOUTH TRAINING

AUGUST, 1ST TO 8TH, 2015
BRIGHTON, U.K

APPLICATION FORM
1. Personal Data
Full Name
Sex

Age

Nationality

Street & no.

City, country

Post code

Mobile

Phone

Personal Email

Dietary
requirements
Speaking

Level of
Very good
English
(Please mark with Good
X)
Basic

Reading
Very good

Writing
Very good

Good

Good

Basic

Basic

2. Organisational Data
Name
Street & no.

Post code

City

Country

Phone

Fax

Web

E-mail

Contact person
Please give a short description of your organisation and its main activities related to
intercultural education.

What is your role in the organisation?

3. Experience
(Note that the indicated space for submitting the information can and should be exceeded)
What kind of experience do you have in working with media as it relates to young people and
social Issues? (please list all experiences you consider relevant)

Have you taken any media related training before?

Have you been participating in some international trainings before? (please list all experiences you
consider relevant)

4. Media Prism
(Note that the indicated space for submitting the information can and should be exceeded!)
Please share with us your understanding of Media Analysis:

What are the main competences you would like to gain/improve as a trainer/facilitator of Media
Related trainings or as a Media Enthusiast?

What are the 3 most attractive aspects of this training course for you?
1.
2.
3.
How do you plan to use the learning gained during this training course (please be specific)?

Anything else you would like to tell us?

5. Practical issues
If you are accepted as a participant on this course, will you require assistance in obtaining visa for
U.K? If yes, please indicate:
Passport no.

Date of issue

Place of issue

Date of expiry

6. What is the estimate of your flight to U.K in Euros? :

7. Choose how much Support you will need for your travel in other to be
able to attend the training (Standard support is 70% of all travels) :
(60% ) ( 70%) (80%) (90%) ?

8. Any other information you will like to share

9. DIETARY REQUIREMENTS OR ANY ALLERGIES?

NOTE: FOR PRACTICAL PURPOSE, ENGLISH WILL BE THE OFFICIAL LANGUAGE FOR DELIVERY OF THE
TRAINING

BUT MOST PARTICIPANTS ARE FROM NON-ENGLISH SPEAKING COUNTRIES

PLEASE RETURN THIS APPLICATION FORM COMPLETED

NOT LATER THAN
JULY 13TH, 2015
TO

info@acdr.org.uk
Selected participants will be contacted by 15th of July, 2015