Training Course
EASTERN EXPRESS
Application Form for Candidates from Programme Countries 
EASTERN EXPRESS TC is organised by 
SALTO-YOUTH Eastern Europe and Caucasus Resource Centre in cooperation with 
Slovakian National Agency of the YOUTH programme IUVENTA-NAFYM

Please type or use CAPITAL letters and write legibly with a black pen. All entries must be filled in.

Personal Data:

The contact details you provide us below will be used for all correspondence!
First Name
[as on your passport]		Family Name
[as on your passport]		
Citizenship 		Date of Birth		Gender	 Female
 Male	
Complete address		
Postal code		Town		Country		
Phone
[with full international dial codes]		Fax
[with full international dial codes]		
E-mail		Website		
Language(s) abilities: Please mention all languages in which you are able to work and indicate your level for each of it (N-none, B-basic, G-good, VG-very good, F-fluent, MT-mother tongue)
	Listening 	Speaking	Reading	Writing	
English					
Russian					
Other language
[please specify]					
Other language
[please specify]					
Do you have any special needs or requirements that the host organisation should know about? (E.g. mobility, medical needs, allergies, dietary restrictions, smoker/non-smoker)

	

Your organisation: 
Name		
Complete address		
Postal code		Town		Country		
Phone
[with full international dial codes]		Fax
[with full international dial codes]		
Email		Website		
Activity level	 local	 regional	 national	 international	
Please describe briefly your organisation
What are the objectives of your organisation?
	
What are its main activities?
	
Who is/are the target group/s you usually work with in your organisation (age, interests, background, etc.)?
	
Please describe your role in the organisation.
What are your functions (youth worker, board member, youth leader ...) and your tasks?
	
In what way are you involved (professional or voluntarily, full or part-time)?
	
Since when have you been involved in youth work?

Motivation and Expectations:
Why do you want to participate in the EASTERN EXPRESS? 
What do you expect to gain professionally and personally from it?
	
Do you have any personal experience in Action 1 - Youth Exchange activities? If yes, please describe.
	
Did you participate already in any other training activities related to the International Co-operation with Partner Countries (previously called Third Countries Cooperation)?
Did you apply for any other international event in this year?
	
Please indicate what is your level of knowledge and experience in those fields:
	Low	Medium	High	
YOUTH Programme 				
Action 1 (Youth Exchanges)				
International Cooperation with Partner Countries				
How do you want to use this Training Course? What possibilities do you have to develop projects within the Action 1 – International Cooperation  afterwards?
	
Please indicate anything else you would like to share about your work, responsibility, skills, experiences, etc., which could be helpful for the selection process.

Please indicate us the name and full contact details of a person to be contacted in case of emergency during the course
Name		
Complete address		
Postal code		Town		Country		
Phone
[with full international dial codes]		Fax
[with full international dial codes]		
Email		

Please take note of the following conditions that will apply if you are selected to take part in the training course.
1.	I commit myself to participate in the whole process, including:
•	to prepare myself carefully for the training course and to do all remote preparation work the team will ask for,
•	to take part in the full duration of the training course
•	to participate in the whole evaluation process 
•	to set up and implement a project within the YOUTH programme afterwards.
2.	I am aware that obtaining a health and a full travel insurance are my own responsibility and at my own expenses. I understand that the information I provided on my special needs does not remove my own personal responsibility for ensuring my own health.
3.	I authorise my National Agency, SALTO-YOUTH EECA Resource Centre and the European Commission to publish, in whatever form and by whatever medium, including the Internet, my correspondence address, information about my organisation and work and pictures taken at the course.
Signature of applicant:	Date: 	

Supporting signatures:
I confirm my organisation/institution/Local Authority wishes to take part in transnational activities through the YOUTH programme and that the above-named person has the support of my organisation and has obtained full permission to be released from his/her usual duties to undertake this training course.
Name and Position (manager/senior officer/board member) of organisation’s representative:

Signature of organisation’s representative:	Date: 	

Applications should be sent to National Agency of YOUTH Programme in your country no later than March 14th, 2005. You will be informed of the results of the selection procedure by March  21st, 2005. 
If for any reason you are no longer able to attend the course, please inform SALTO-YOUTH EECA RC as soon as possible so that the SALTO-YOUTH Resource Centre can ensure a replacement from the waiting list.