MELIAL GRU WS Learner Application Form

8/13/2019 MELIAL GRU WS Learner Application Form

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GRUNDTVIGWORKSHOPS

Registration form and agreement WS-learner28!"2"!!

LIFELONG LEARNING PROGRAMMEGRUNDTVIG WORKSHOPS

Learner application for

Please send this application form duly completed and signed to:

- the organisation which organises the Workshop (Workshop Organiser)

Dea!line for "en!in# t$e re#i"tration for%& 31/12/2012

If your candidature to this Workshop is accepted, the Workshop Organiser

will return to you a signed copy of this form.

I ' I!entification of t$e Wor("$op%

Title of t$e Wor("$op !"I# $I%!' O& #"*$% $!#&+!& !$I#$

Ho"t in"tit)tion O*% P#&%I'IP#%IO+ #+" I+%!&'*$%*$ "I#$O/*!#O'I#%IO+

Date" of t$e Wor("$op 01.23.4203 43.23.4203

0%o 5e pre-filled 5y the Workshop organiser0

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II ' I!entification of t$e can!i!ate learner

II.1. Contact details

Title *Mr+M", Fir"t nae

Fail- nae

A!!re""

Po"tco!e .it-

.o)ntr-

Telep$one % Telep$one /

Mo0ile Fa1

E'ail a!!re""

II.1. Other information

Date of 0irt$

Nationalit-

Occ)pation *if

applica0le,2 If retire! +)neplo-e!& 3$at

forer 4o0 !i! -o) !o5

Special re6)ireent"for tra7el" an!+or!)rin# t$e "ta-

*o0ilit-8 !ietar-8e!ical8 etc9,

E1perience 3it$ forerinternational acti7itie"

Moti7ation to participatein t$i" 3or("$op

a6. 012 words

Lan#)a#e" "po(en

Lan#)a#e" )n!er"too!

Ot$er inforation -o)3o)l! li(e to ention

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GRUNDTVIGWORKSHOPS


II.3 Other questions(to be customised by the Workshop Organiser if needed)

Ha7e -o) participate! inot$er GRUNDTVIG

pro4ect"5

Ha7e -o) an-e1perience 3it$ a""e!ia8 pre""8

p$oto#rap$- or ot$erean" of

co)nication5

W$ic$ i" -o)r

relation"$ip 3it$ ADULTEDU.ATION5

Do -o) repre"ent an-or#ani"ation5 In

afirati7e ca"e8 plea"e8an"3er t$e follo3in#

6)e"tion"2

! +O

Nae of t$e

or#ani"ation

.o)ntr-

We0"ite

O04ecti7e"8 acti7itie"

an! tar#et #ro)p

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.ANDIDATE LEARNER

I confirm that I understand and intend to o5ey to the following principles and rules:

0. %he Workshop Organiser will select candidates according to selection rules whichha7e 5een appro7ed 5y hisher $ifelong $earning /rundt7ig +ational #gency.%hese include rules on the minimum num5er of learners from a 7aried num5er ofcountries8

4. 'andidates may 5e selected, re9ected or registered on a reser7e list8

3. %he Workshop Organiser may consult the selected learners to organise their tripsand accommodation8

. ;y signing the present document, the candidate learner commits himself herselfto:

a) participate in only one Workshop throughout the !* within 3 years5) if case of selection:

i. attend the Workshop

ii. comply with all arrangements negotiated for hisher participationand to do hisher 5est to make the Workshop a success

iii. fill in and sign a final e7aluation form at the end of the Workshopand send a copy of it to the +ational #gency of hisher country0.

c) in case of selection 5ut non attendance: present e7idence of forcema9eure,

d) in case of partial or non attendance and no presentation of e7idence of

force ma9eure, reim5urse the Workshop Organiser of all costs incurred dueto this non-attendance.

"ate:

Documents

MELIAL GRU WS Learner Application Form