EDUCATION

AND
CULTURE

YOUTH IN ACTION
PROGRAMME
EUROPEAN VOLUNTARY SERVICE

Application form
For
The volunteer

EUROPEAN
COMMISSION
YOUTH IN ACTION PROGRAMME

European Voluntary Service

Volunteer data
Name of the project you are
applying for (if known) and ref.
number:

Name and address

Photo

First name

Last name

Date of birth

Place of birth

Gender Female Male

Nationality
Country of legal
residence if different

Street address

Postcode Town

District or region Country

E-mail
Prefix number prefix number
Telephone 00 34 Fax

Background information

What is the highest level of education

primary education
you have completed (check one box
only) secondary education
vocational training
higher education

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 What are your language skills?
Language(s) Level
Please use the following codes:
1 = mother tongue, 2 = fluent,
3 = good, 4 = basic.

What is your current situation? (Please

working
check one box only.)
unemployed
training or studying
other
Education and training

Dates Add separate entries for each relevant course you

have completed, starting from the most recent.
(remove if not relevant, see instructions)

Title of qualification awarded

Principal subjects/occupational
skills covered

Name and type of organisation

providing education and training

Level in national or international

classification (remove if not relevant, see instructions)

Work experience

Dates Add separate entries for each relevant post occupied, starting
from the most recent. (remove if not relevant, see instructions)

Occupation or position held

Main activities and responsibilities

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 Type of business or sector

Do you have special needs that would need to be taken into account (dietary needs, problems of mobility,
health care, etc.)

Do you have a driving licence? yes no

What other relevant skills would you like the hosting project to know?

Motivation

Please describe why you want to participate in the European Voluntary Service, including your expectations
concerning volunteering, and your possible contribution to the hosting project.

What are the defining characteristics of your personality (your strengths, weaknesses, values, role of friends in
your life, and the importance of school or work).

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 I would like to go for 2-12 months (minimum 2, maximum 12 months)

I am available from

I would like to go to the following country :

Please tick ( ) a maximum of 3 boxes (❏ ))

UK Belgium Bulgaria

Ireland Germany Poland

ITaly Luxembourg Hungary
Spain Austria Czech Republic
Portugal Denmark Slovenia
France Norway Slovakia
Netherlands Iceland Romania
Sweden Greece Estonia
Finland Latvia Other:

Main themes for the activities

Please tick ( ) a maximum of 3 boxes (❏ )

Art and culture Social exclusion (in general) Anti-drugs/substance abuse

Environment Measures against delinquency Youth sports
Heritage protection Youth information Media and communications
Rural development Youth policies European awareness
Urban development Equal opportunities Youth leisure
Health Anti-racism/xenophobia Other:
I the undersigned certify that all information contained in this application is accurate. I agree that the data
contained in this application will be made available to hosting organisations of my choice, to the National
Agencies, and to the European Commission.

Date Place

Signature

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