NEXT/CHANGE 1-2 personnes

NEXT/CHANGE

APPLICATION FORM FOR EXCHANGE PROJECTS FOR 1 TO 2 PEOPLE
A - Applicant information
Name

First NameLast Name
Position at the cinema
Email
example@example.com
Phone Number

Country CodePhone Number
Cinema
Number of screens
Company name
Company address

Street

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Country CodePhone Number
Have you previously participated in a Europa Cinemas event (Conference, Lab, Cannes Network Meeting, etc.) or been part of a project (Collaborate to Innovate, Next/Change, Label Jury, etc.)?
B - Project Description
Please specify the areas in which you need to improve your skills:

Other
Project description: what are the difficulties you are facing in your cinema(s), what you wish to develop, why have you chosen this country and this area, what inspires you in the cinema(s) you have chosen (maximum 500 words):

Please fill in this table with the information about the cinema(s) you want to visit

Objectives
Expected results
Are you planning to use the learnings of this travel to draft a specific project (for example a Collaborate to Innovate application, Training Boot Camp project)?
If you answered 'yes' or 'maybe' please precise:
Provisional travel schedule including the dates of travelling and the visits each day
Please join to this form a letter of acceptation (or confirmation by email) from the host cinema

Cancelof
C - Expenses Details

Expenses details

Rows	Cost per unit	Number of units	Total cost	Support requested to Europa Cinemas*
Accomodation
Travel

Amount of support requested to Europa Cinemas*
*Europa Cinemas will only cover part of the cost of travel (max 50% in the limit of 200€) and accommodation expenses (max 50% in the limit of 100€/night for 5 nights maximum).

Payments will be made on the reception of eligible invoices and completion of the reporting.
Name of signatory
I herewith agree to submit a report after the exchange, which results will be communicated to the wider network and sector to encourage peer-sharing:
Date

DayMonthYear
Date
Hour Minutes
Signature
Should be Empty:

NEXT/CHANGE