/ GRUNDTVIG
WORKSHOPS
Registration form and agreement WO-learner
2011-1-IT2-GRU13-26306

LIFELONG LEARNING PROGRAMME

GRUNDTVIG WORKSHOPS

Learner application form

Please complete this form, sign it and save it as

YOURCOUNTRY_YOURNAME_RML_application_2012.doc

[example: SPAIN_TORRES_RML_application_2012.doc]

Then, send it to

- the Workshop organiser:

- the Grundtvig National Agency in your country

- the Grundtvig National Agency in the country where the Workshop will take place.

Addresses of National Agencies are available on the following web page:

Deadline for sending the registration form[1]: 31 JAN 2012

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

Title of the Workshop / Raw Material: Light
Host institution / Cortona Sviluppo SRL
Dates of the Workshop / 10-17 June, 2012

II - Identification of the candidate learner

II.1. Contact details

Title (M/Ms/Mrs) / First name
Family name
Address
Postcode / City
Country
Telephone 1 / Telephone 2
Mobile / Fax
E-mail address

II.1. Other information

Date of birth
Nationality
Occupation (if applicable). If retired / unemployed: what former job did you do?
Special requirements for travels and/or during the stay (mobility, dietary, medical, etc…)
Experience with former international activities
Motivation to participate in this workshop
Languages spoken
Languages understood
Other information you would like to mention

II.3 Other questions

Please paste below TWO photographs that you took, write their captions and explain why these imagesare meaningful to you (max 5 lines each). The two images may belong to the same project, or to different bodies of work: please mention which is the case. Both colour and BW photographs are acceptable; horizontal, vertical or square formats are acceptable, the longest side not exceeding 660px. Please note that no graphics or digital manipulations are allowed, except for minor brightness/contrast adjustments. If you are selected, you will be asked to present these images to the workshop team in Cortona.
Please paste below ONE low-resolution photograph by an author that you consider relevant for your photographic work; report its source and caption (if available), and explain why this image is meaningful to you (max 5 lines).
When, would you say, did you really start your practice of photography? How did it happen? (max 5 lines).
How would you evaluate your image-editing skills in the digital darkroom? Please provide three examples of basic operations that you can perform on your own. There is no need to mention specific software, just focus on actual operations (max 5 lines).
Do you see any way that your participation in this workshop can benefit others, upon your return in your home country?
If selected, can you participate in the workshop with your own SLR digital camera? Brand and model are irrelevant for selection purposes.
This question is NOT relevant for selection purposes. If selected, do you plan participating in the workshop with your own laptop computer?

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 its Lifelong Learning / Grundtvig National Agencies. 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)provide true and verifiable answers to all questions of this application form

b)apply for only one Workshop throughout the EU for the year 2011-2012

c)in case of selection:

  1. not to apply to any other Workshop for the next 3 years
  2. attend the Workshop
  3. comply with all arrangements negotiated for his/her participation and to do his/her best to make the Workshop a success
  4. fill in and sign a final evaluation form at the end of the Workshop

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

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

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: ……………………………………………………………………………………………………………………………………..

DATES: ……………………………………………………………………………………………………………………………………

LOCATION: ……………………………………………………………………………………………..………………………………

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

1

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

[2]And stamp of the organisation