TEACh - Teaching European Active Citizenship
Application Form

Personal Information*
Mrs Ms Mr      
First name and Surname Country
Employing Organisation Phone Number
Office Address Fax number
Post code & City E-mail
*ALL fields are required!

Courses during 2008 and 2009

Course Grundtvig/
Comenius Series		 Location Period Course
Fee EURO		 Full board and lodging EURO*
TEACh XIII FI-2009-066-003 Celje/Slovenia 29Sept-3 Oct 2009 590 390
TEACh XIV FI-2009-066-003 Rabat/Malta 20-24 Nov 2009 490 500
TEACh XV FI-2009-066-003 Milan/Italy 12-16 Feb 2010 490 500
           
           
* The price includes accommodation in double rooms for a maximum of 6 nights. A supplement of 30€/night will be charged for single room accommodation.

Choose from above the course or courses (maximum two choices) you would like to attend, and mark your choice below
1st choice*
2nd choice
*required field

If you are accepted, would you agree that your contact details be shared with other participants in th e TEACh Course? Yes Part of the course related material will be available electronically. Do you have an Internet connection that would allow you to download these materials and possibly take part in on-line meetings? Yes
No No

Payment details
Once your Application is accepted by your National Lifelong Learning Agency, how would you like to pay?
Please send me an invoice
I will pay in cash upon arrival
I would like to pay by creditcard (We will contact you for the details)

In order to better tailor the course content and activities to each specific group, we would kindly
ask you to provide the information below. This information will be treated in confidentiality and
will only be made available to the TEACh Team.

Year of Birth

Have you worked with Active Citizenship before? Yes No

If 'Yes', please give details below in maximum 50 words.



Please describe below your educational and professional background (please select only relevant information,
including voluntary activities, recent employment, etc.). Max 100 words.



Please explain briefly (in no more than 100 words) how the course will help you in your work
- professional or voluntary. This part is important when considering your application.



Please add below any other details you think the organisers might need to be aware of as far as you are
concerned. Include any special needs (dietary, physical disabilities, etc.).



How have you found out about the TEACh Courses?



Please submit the form by clicking on the "submit" button below. Alternatively,
you can print it and fax it to +358-19-2226011.