CREA(C)TION Empower young people to use social and digital media in the youth work

Training Course Period: 23rd-31st October 2012 Location: Sovata/Szovta

Please type or use CAPITAL letters and write legibly. If necessary, please attach an extra sheet. To be filled in English

APPLICATION FORM

DEADLINE FOR SUBMITTING THIS APPLICATION FORM TO CEMO: Please return by e-mail to: szalasi.orsolya@cemo.ro, info@cemo.ro I. INFORMATION ON THE APPLICANT Name Surname Main Profession or occupation Address Postal Code City Gender Date of birth M F

././.

Please note that all correspondence will be sent to this address, so please ensure it is complete! Mobile Fax E-Mail / @ Native Language Vegetarian Special requests
Civic Engagement Movement (CEMO, Tirgu Mure, 3. Deva str, zip code: 540430, Romania Phone : +40-770-908-264 , mobile: +40-747-34-09-62; Email: info@cemo.ro ; Website: www.cemo.ro

Contacts Skype Facebook /other

Vegan

Meat Meals

How do you use the Internet? What do you do? How often? Why? Do you mainly use the Internet to play games, find friends, learn online, shop online?

What do you think are the advantages and disadvantages of the Internet?

II. INFORMATION ON THE ORGANISATION/INSTITUTION, IF APPLICABLE Name Address City Phone E-Mail III. EXPERIENCE In what capacity are you involved in the life of your community? I am occasionally involved in Running community projects community projects I am planning to be Volunteer involved in Planning to be a community projects volunteer I am not involved in community projects What kind of activities are you involved in? (Please indicate briefly the target groups and themes or aims of the activities) Contact numbers Fax Internet Address Postal Code Country

Civic Engagement Movement (CEMO, Tirgu Mure, 3. Deva str, zip code: 540430, Romania Phone : +40-770-908-264 , mobile: +40-747-34-09-62; Email: info@cemo.ro ; Website: www.cemo.ro

Have you ever received any Training in Active Participation, or in the fields (social media, active participation, solidarity) of the course before?

IV. MOTIVATION, EXPECTATIONS and FOLLOW UP What is your motivation to take part in this course? Please, mention your training needs: what would you like to get from this training course?

Follow-up After the training the participants will need to take part in the development of a Social Media web page, created by the organizers. Please explain how are you going to be involved in the development of the Social media web page (creation of blogs, short films etc.)?

Please indicate where you got the information about the course

I commit myself to actively participate in the Training Course CREA(C)TION in its full preparation process (before the course) and duration from 24th -31st October 2012 in Sovata/Szovata.. I am aware that travel costs can be reimbursed (according to financial details in the call) only if I take part in whole duration of the Training Course. Signature: Place and date:

Civic Engagement Movement (CEMO, Tirgu Mure, 3. Deva str, zip code: 540430, Romania Phone : +40-770-908-264 , mobile: +40-747-34-09-62; Email: info@cemo.ro ; Website: www.cemo.ro