A choice of social responsibility TRAINING COURSE ERASMUS+ Mobility of Youth Workers “THE RIGHT OF BEING HUMAN” February 27th 2015 / March 8th 2015 Nardò (Lecce) - ITALY APPLICATION FORM First Name and Surname (as in your passport): Gender: Date of birth (day/month/year): Citizenship: Rinascita Società Cooperativa Sociale – Legal Address: Via Dante, 145 73043 Copertino (LE) Italy www.cooperativarinascita.org [email protected] Certification ISO 9001:2008 n° 244276-1 Registration to Regional Register of Social Cooperative - section “A/B” n° 794/A e 475 B VAT IT03352220754 Tel / fax +39083948879 IBAN IT90S0860379580000000302077 A choice of social responsibility Personal Address (street, postal code, town and Country): E-mail: Contact phone number: Sending Organisation: Special wishes and dietary requirements: Any serious illnesses, disabilities, allergies: Language skills (What languages do you speak? Put: G for good, F for fair, S for slight): Rinascita Società Cooperativa Sociale – Legal Address: Via Dante, 145 73043 Copertino (LE) Italy www.cooperativarinascita.org [email protected] Certification ISO 9001:2008 n° 244276-1 Registration to Regional Register of Social Cooperative - section “A/B” n° 794/A e 475 B VAT IT03352220754 Tel / fax +39083948879 IBAN IT90S0860379580000000302077 A choice of social responsibility Give details of your voluntary/community work experience: Please, describe your experience in the field of human rights: Please, describe your experience in tools of promotion and communication/ photo and video-making/ creativity: What is your main motivation to take part in this Training Course? What do you expect to gain from your participation? Rinascita Società Cooperativa Sociale – Legal Address: Via Dante, 145 73043 Copertino (LE) Italy www.cooperativarinascita.org [email protected] Certification ISO 9001:2008 n° 244276-1 Registration to Regional Register of Social Cooperative - section “A/B” n° 794/A e 475 B VAT IT03352220754 Tel / fax +39083948879 IBAN IT90S0860379580000000302077 A choice of social responsibility Any other information/comments? Rinascita Società Cooperativa Sociale – Legal Address: Via Dante, 145 73043 Copertino (LE) Italy www.cooperativarinascita.org [email protected] Certification ISO 9001:2008 n° 244276-1 Registration to Regional Register of Social Cooperative - section “A/B” n° 794/A e 475 B VAT IT03352220754 Tel / fax +39083948879 IBAN IT90S0860379580000000302077