Application for participants
Open Your Mind to Diverse World
10-16th April 2009
Mikuszewo (near Poznan), Poland

It is very important that you answer ALL the questions below!

Name

	Surname	
Organisation

	Official address and telephone number of the sending organization: 	
Tel/Mob (please type complete number with country code)

e-mail address

	Skype/yahoo id/other
	
Date of birth:	Sex: 

	Nationality: 

Special requirements:

	Estimated travel costs (in euro):	
Please indicate your previous and current involvement and role in your organisation:

	
What are the aims and objectives of your organization?

	
Please describe shortly your experience abroad (date, place, project name, work you did)

	
Did you have a possibility to evaluate your experience abroad? If so how it was done?

	
What is your motivation to participate in this training?

	
What are your expectations towards the training?

	
How could you possibly use the knowledge and skills acquired during the training:

	
How you can contribute to the seminar (example: artistic or musical skills, games)? 

	
Please write name and contact details of the reference person from your sending organization:

	

In case you need a visa for entering Poland, please give: 

Name as written in your passport: ___ ___________________
Passport number:  ___ ___________________
Date of issue: ___________________________
Date of expiry:_______ ___________________
Issued by:_______________________________
Date of birth: ________ ___________________
Official home address: ________ ___________________

Please send back to the e-mail addresses: g.pulawska@gmail.com and wojszczepanik@icpnet.pl  by 10th of March 2010