Application to "Media Creator #2: Design & Creativity"

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Application Form

Email *

First Name: *

Surname: *

Name you want to be called in the event:

Gender: *

Male

Female

Full address (number of the apartment, street, zip code, city, country): *

Country of residence: *

Poland

Lithuania

Greece

Romania

Czech Republic

Italy

Nationality: *

Facebook profile link address: *

Date of birth and place of birth *

Mobile number: *

Level of English: (basic, good, excellent) *

Basic

Good

Excellent

Study or Occupation: *

Are you with fewer opportunities?

(1) Economic:- unemployed- low standard of living, low income, dependence on social welfare system- in debt or with financial problems.

(2) Social:- facing discrimination because of gender, ethnicity, religion, sexual orientation, disability, etc.- limited social skills or anti-social or risky sexual behaviours- in a precarious situation- (ex)offenders, (ex)drug or alcohol abusers- young and/or single parents; orphans- young people from broken families

(3) Disability:- mental (intellectual, cognitive, learning)- physical, sensory- other disabilities

(4) Educational difficulties:- with learning difficulties- early school-leavers and school dropouts- lower qualified persons- with poor school performance

(5) Cultural differences:- immigrants or refugees or descendants from immigrant or refugee families- belonging to a national or ethnic minority- with linguistic adaptation and cultural inclusion problems

(6) Health problems:- chronic health problems, severe illnesses or psychiatric conditions- with mental health problems

(7) Geographical obstacles:- from remote or rural areas- living on small islands or peripheral regions- from urban problem zones- from less serviced areas (limited public transport, poor facilities, abandoned villages)

I do not belong to any of the above categories

Diet / Allergies / Special Needs: *

Contact person in case of emergency (full name, address, phone number, relationship with you): *

FOCUS QUESTIONS

What is your motivation to join in "Media Creator #2: Design & Creativity"?: *

How do you expect to improve by participating in this event?: *

What organization(s) / companies / startups are you connected with? Please add a short description and your role in them

What is your media / creativity / design experience until now? *

International experience until now: how many Erasmus+ projects you have participated in so far? *

This will be my first time

2-5

more than 5

Please describe some of International experiences if you had any and what was your biggest learning?

What do you do for your self-brand/image? *

Social Media accounts: please provide a full and detailed list of links and indicate how often you use them (eg. how many times per week, month, year) *

How do you use these social media for your self-branding + how would you like to use them? *

What is your experience in video making? Please present some of your latest works in links (no matter language) (preferably connected with self branding) *

Will you bring a photocamera/videocamera? *

Yes

Maybe

Will you bring a laptop? *

Yes

Maybe

Are you willing to do a follow-up self-change campaign to improve your self-brand? What will it be? *

Other remarks:

I agree that group photos and videos (where 2 or more participants are visible) taken in the project can be fully used in any material by Abroadship.org: *

I agree

I disagree

I read the info-pack on Abroadship.org and agree with all the conditions and details stated *

Agree

Disagree

Send me a copy of my responses.

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