EVS with ELIX - ELEPAP 2015/2016
Please answer all the following questions in English (do not worry about mistakes – they won’t count against you!) All data will be strictly confidential.
Last Name(as written in your ID card):
First name/s(as written in your ID card):
Gender:
Female
Male
Date of Birth:
Age:
Place of Birth (city and country):
Nationality:
Address (street, number):
Address (city, postal code):
Country:
E-mail:
Phone (mobile phone with the country code - eg. +30 123456789):
Skype:
Living situation. Are you currently (please select):
Studying
Working
Unemployed
Self-employed
Other
Do you have any disabilities or special health needs?
If yes, please specify:
Do you hold driving licence:
Yes
No
Language spoken and to what level:
0 - None 1 - Basic 2 - Good 3 - Very Good 4 - Excellent 5 - Mother tongue
English
French
German
Italian
Spanish
Greek
Do you speak some other language?If yes, please specify to what level
1. Please give a short description of yourself, your background, your life at the moment, your hobbies, past experiences and future plans:
2. What is voluntary service for you? What does being a volunteer mean to you?
3. Have you already participated in any voluntary or associative activities? If « yes » where, when, for how long, what type of activity and with which organisations?
4. Why would you like to take part in this specific EVS project?
Please explain why you think you can carry out this post. Read the description and requirements carefully and show us how you meet the criteria.
5. Do you have any worries or fears about becoming an EVS volunteer? What challenges do you think you will face?
6. Have you already travelled or lived abroad? If « yes » where, when, for what reason and for how long?
7. What kind of difficulties do you think you will face or encounter while living for a longer period of time abroad, in a foreign country, with a culture different from yours?
8. What kind of knowledge or skills would you like to gain? What would you like to learn while volunteering?
9. What are you planning to do after your Voluntary Service Programme finishes?
10. And finally… How would you describe yourself?
We have listed some key words that may help you to describe yourself. Please check the words which seem to describe you the best and add other words if you wish. You may ask a friend to help you.
musical
artistic
leader
easy-to-please
shy
organised
moody
patient
dancer
noisy
reader
follower
listener
talkative
independent
quiet
tidy
early-to-bed
flexible
religious
athletic
forthright
worrier
confident
prudent
caring
stubborn
party-goer
emotional
lacking confidence
Other:
Additional Information
Please include any additional information that is relevant to your application and that you haven’t already mentioned.
I confirm that I already contacted a sending organisation in my home country.
Please give the name of the organisation, PIC code, contact person, email and telephone number
Name:YAP (Youth Action for Peace) Italia
EVS Reference Number:2013-IT-177
PIC number: 947888851
EVS Contact Person:Stefano VARLESE
Address:Via Marco Dino Rossi 12G
Postcode: 00173
Town/City: Rome
Country: Italy
Tel.(0039) 067210120
Fax: (0039) 067220194
E-mail:
Website:
I confirm that
I read the description of the project.
I'm available to participate for the full duration of the EVS - 1/10/2015-30/06/2016.
I have not participated in an EVS project longer than 2 months (short term).
that all the information given in this application is true to the best of my knowledge.
I understand that if I am offered the place in this programme I must provide ELIX with a Certificate of Good Conduct.
Signature:Date: