REGISTRATION FORM to ERASMUS+ and VOLUNTEERING PROJECTS ESC

Your name and family name (latin letters only as in ID or passport)*

First NameFamily Name

Date of birth DD/MM/YYYY*

Date

Date of birth DD/MM/YYYY*

Date

Gender*

Citizenship/ Country of residence*

Home address (only city)*

Your Email*

Confirmation Emailexample@example.com

Mobile phone (including country code)*

Area CodePhone Number

Facebook / Instagram account (link) or other social media account*

Sending Organization (if you don't know – write NO)*

Your PRN (Personal Registration Number 10 or 16-digits) in European Youth Portal: IT IS OBLIGATORY FOR PARTICIPATION IN ANY ESC VOLUNTEERING PROJECT. *

Don"t have PRN? REGISTER and get it here: https://europa.eu/youth/solidarity_en

Name of your sending organization. If you don't know - write NO.*

For any Individual Volunteering or Erasmus+ project participant must have Sending/Supporting organizaiton. After filling this application we will send your data to our Partner organization in particular Project for approving your participation.

Position in your sending organization. If you don't have any position – write NO*

for example - youth worker, volunteer, etc

Have you ever participated in any of Erasmus + or ESC programmes? (YE, TC, PBA or Seminar, volunteering or internship)*

No, this is the first timeYes, 1-4 timesYes, 5 or more times

Language proficiency of English*

BasicMediumGoodExcellent

Please describe your experience in the field of non-formal education/volunteering*

Depending of the type of the project please describe your previous experience

Please describe your motivation/ interest in participation to this project*

Please describe your experience in the field of the project topics*

Please give detailed examples on how you could disseminate (share and spread) the project results?*

For example (creating posts/photos/videos about the project in your social media, organizing workshops and activities after project, ect)

Food restrictions, allergies etc*

Please write if you have any allergic. Your written restrictions will be taken into account during the project for providing food

Health problems affecting participation during whole period of activity*

If you have any

Do you consider yourself to be a person with fewer opportunities?*

YesNo

If your answer to previous question is YES, please mark, which obstacles do you meet daily in your life (you can check several boxes)

Social obstacles – young people facing discrimination because of gender or ethnicity or religion or sexual orientation or disability etc. – young people with limited social skills or anti-social or risky sexual behaviours – young people in a precarious situation – (ex)offenders or (ex)drug or alcohol abusers – young and/or single parents and orphans – young people from broken familiesEconomic obstacles – young people with a low standard of living or low income or dependence on social welfare system – in long-term unemployment or poverty – young people who are homeless or young people in debt or with financial problemsDisability: physical – mental – intellectual or sensory disabilitiesEducational difficulties – young people with learning difficulties – early school-leavers and school dropouts – lower qualified persons – young people with poor school performanceCultural differences – young immigrants or refugees or descendants from immigrant or refugee families – young people belonging to a national or ethnic minority – young people with linguistic adaptation and cultural inclusion problemsHealth problems – young people with chronic health problems or severe illnesses or psychiatric conditions – young people with mental health problemsGeographical obstacles – young people from remote or rural areas – young people living on small islands or peripheral regions – young people from urban problem zones – young people from less serviced areas (limited public transport or poor facilities or abandoned villages)

Breefly describe all your selected obstacles of fewer opportunities*

By registering for selected project I confirm that I am not included in any other project by Erasmus+ or ESC programme during whole period of activity to avoid double financing*

Yes

By filling out this questionnaire, I agree that my personal data will be processed for the following purpose: for the selection of participants and the creation of databases for the selection of candidates for voluntary work projects with the aim of informing about the decision to participate in the project, as well as informing about a specific event and project suitable for a specific target group developments in Latvia and abroad.*

Yes

We inform you that the data specified in the questionnaire will be processed and collected for the purpose of: selection of project participants, which includes candidate evaluation and participant registration; preparation and issuance of a certificate of participation; storage of personal data for the purposes of preparing reports and statistics, as well as transfer of personal data to third parties. Data processing manager: Culture association Alternative Reality, Daugavmalas street 34-27, Saulkalne, Salaspils prov., Latvia, LV-2117; tel. +371 22189430; e-mail address: alternativarealitate@gmail.com.Reason for personal data processing: The survey is carried out as part of the selection of candidates for Erasmus+ or voluntary work projects.Duration of personal data processing: permanent.*

Yes

I confirm that my personal data provided in this application is real and I agree that they will be processed for the selection and participation in this project, only.*

Yes

Thank you for your willing to participate in the program!

After receiving your application we will conduct selection of participants. For selected participants we will organize on-line interview and inform you by sending you email.

APPLICATION FORM to register for ERASMUS+ and ESC Volunteering projects

Are you a person with fewer opportunities?