/ GRUNDTVIG
WORKSHOPS
Registration form and agreement WS-learner
19/09/2011

LIFELONG LEARNING PROGRAMME

GRUNDTVIG WORKSHOPS

Learner application form

Please send this application form duly completed and signed to:

- the organisation which organises the Workshop (Workshop Organiser)

Deadline for sending the registration form[1]: 31 August, 2013

If your candidature to this Workshop is accepted, the Workshop Organiser will return to you a signed copy of this form.

I - Identification of the Workshop[1]

Title of the Workshop / Movers and Shakers for Literacy
Host institution / Institute of Cultural Affairs, Spain
Dates of the Workshop / 02/11/2013 - 11/11/2013

II - Identification of the candidate learner

2.1. Contact details

Title (Mr/Ms) / First name
Family name
Address
Postcode / City
Country
Telephone 1 / Telephone 2
Mobile / Fax
E-mail address
Skype
Best time and day to contact you

2.2. Other information

  1. Date of birth

  1. Nationality

  1. Occupation (if applicable). If retired / unemployed: what former job did you do?

  1. Special requirements for travels and/or during the stay (mobility, dietary, medical, etc…)

  1. Experience with former international activities

  1. Motivation to participate in this workshop
/ Max. 150 words
  1. Languages spoken

  1. Languages understood

  1. Other information you would like to mention

2.3 Other questions

REQUIREMENT / NEEDS (Please tick)

No Disability please, specify if any: ______

Wheelchair User/Mobility Difficulties

Food requirements, please specify: ______

Religious observance, please specify: ______

LANGUAGES (Please tick)

Although applicants won´t be required to have a high level of English in order to participate, please fill in the following information for helping the organizers to meet any needs arising within this field.

English Language Excellent Very Good Good Beginner

Other languages:

______Excellent Very Good Good Beginner

______Excellent Very Good Good Beginner

Tell us about the group profile you work with within the field of literacy (max 80 words)

What are you expecting to gain from the course(max 50 words)

Please, explain how you would contribute to multiplying the effect of this workshop, including networks or groups you are involved with. Specify name and out reach(max 80 words)

Who is eligible to attend this Grundtvig Workshop?

All teachers and staff working within the field of adult literacy, from countriesparticipating in the Lifelong Learning Programme (LLP) can attend the Workshop.

The programme is open to participants from the 33 participating countries: 27 Member States EFTA/EEA countries – Iceland, Liechtenstein, Norway and Switzerland, 2 candidate countries – Croatia and Turkey

"Overseas countries and territories" defined by Council Decision 2001/822/EC (amended by Council Decision 2007/249/EC). These can be found in the LLP Guide 2012: Part I General Provisions.

Participant´s selection profile:

  • Adults who haven’t had yet an experience of participating in an international workshop and live in rural areas where access to adult learning is scarce.
  • Adults who are involved in grassroots / community based activities related to the subject of the workshop, preferable women and men from diaspora groups.
  • Adults strongly motivated and committed to disseminating the outcomes of the workshop experience within their community.
  • Adults that areabletoparticipate during the fulldurationofthe 5-day workshop.
  • Adults that have not received any grants for other workshops from Grundtvig in the last three years.

(* ) There are limit of places from participants coming from one country (7). Maximun number of participants for the workshop: 20

(**) Adult learners from Spain may also apply but will not be eligible for funding.

Participants selected will be notified at on September 9th, 2013 for making the necessary travel arrangements in coordination with the organizer.

CANDIDATE LEARNER

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

  1. The Workshop Organiser will select candidates according to selection rules which have been approved by his/her Lifelong Learning / Grundtvig National Agency. These include rules on the minimum number of learners from a varied number of countries;
  1. Candidates may be selected, rejected or registered on a reserve list;
  1. The Workshop Organiser may consult the selected learners to organise their trips and accommodation;
  1. By signing the present document, the candidate learner commits himself / herself to:

a)participate in only one Workshop throughout the EU within 3 years

b)if case of selection:

  1. attend the Workshop
  2. comply with all arrangements negotiated for his/her participation and to do his/her best to make the Workshop a success
  3. fill in and sign a final evaluation form at the end of the Workshop and send a copy of it to the National Agency of his/her country[1].

c)in case of selection but non attendance: present evidence of force majeure,

d)in case of partial or non attendance and no presentation of evidence of force majeure, reimburse the Workshop Organiser of all costs incurred due to this non-attendance.

Your registration implies that you authorize the European Commission and the National Agency to make free use of the photographs, films and recordings bearing your image or voice in all type of publications, television broadcast or communications via the Internet for information or education purposes only. These photographs, films and sound recordings may be included and archived in the European Union’s online database, accessible to the public free of charge online.

Date: ………………………………………Signature: ……………………………………………………………………

WORKSHOP ORGANISER

We confirm that the above mentioned candidate has been accepted to attend the following Workshop and will do our best to provide him/her with a successful experience, as described in our application form.

TITLE: Movers and Shakers for Literacy

DATES: 02/11/2013 - 11/11/2013

LOCATION: Segovia, Madrid

Date: ………………………………………Signature[2]: ………………………………………………………………..…

1

[1]To be pre-filled by the Workshop organiser

[1]

[1]Coordinates of all National Agencies:

[2]And stamp of the organisation