January - 7 February 2014
This form should be sent to alina.or.seledka@gmail.com no later than 16 January, 2014
| First Name (as in your passport):
| Family name/ surname (as in your passport):
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| Address:
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| City and index:
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| Country:
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| Gender:
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| Age:
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| Email:
| Mobile:
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| Special considerations/others (dietary, special needs, etc):
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| Do you have valid Shengen visa?
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| If you need visa please indicate nationality, passport number, date of issuing and expiry, and the issuing authority
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| person to be contacted in case of emergency, please indicate full contact details, i.e. phone number, e-mail, address
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Your organization
| Name of organization, contacts:
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| Short description of activities of organization:
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| Your position/role in the organization
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| Reference (please provide the name and contacts of the person who could recommend you to take part in the seminar, e.g. Chairperson, Board member, Director, etc)
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Experiences
| Level of English (from 1 to 5, 1 = Not at all, 2 = Poor, 3 = OK, 4 = Good, 5 = Fluently)
Spoken: Understood: Written:
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| Other language
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| Previous international experiences? (please list)
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| Experiences of work for organizations in your home countries? (Please describe)
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Expectations and Motivation:
| Please give us an idea of your needs and expectations towards this meeting, of your potential contributions to it, and how your participation in this meeting will be beneficial for you, for the other partner organisations and participants, for your organisation, and for the young people are working for. Please be specific and make specific reference to the topic of the meeting!
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| Multiplication, dissemination and follow-up: Please explain how you will ensure a transfer of the learning points and outcomes of the meeting back to your organisation, and how you plan to implement and disseminate the results of the meeting your daily work and among your networks and partners.
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| OPTIONAL: please feel free to give us any kind of feedback, input, wishes, recommendations etc for any aspect of this meeting
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Thank you!
This form should be sent to alina.or.seledka@gmail.com no later than 16 January, 2014
Please note that selected participant(s) will be asked to participate in preparation to seminar, and also in follow-up activities (e.g. to make a presentation for Belarusian NGOs, to write an article).
