Canada-ukraine core-health /core-eco program 2012-2013 icon

Canada-ukraine core-health /core-eco program 2012-2013




НазваCanada-ukraine core-health /core-eco program 2012-2013
Дата01.06.2012
Розмір27.4 Kb.
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CANADA-UKRAINE

CORE-HEALTH /CORE-ECO PROGRAM 2012-2013

Application Form



  1. Name (as in the international passport):____________________________________________________

  2. Date & place of birth: __________________________________________________________________ ______________________________________________________________________________________

  3. Current home address: _________________________________________________________________ ______________________________________________________________________________________

  4. Permanent address: ____________________________________________________________________

______________________________________________________________________________________

  1. Telephone numbers (at home, in Ostroh, if available, and cell): ________________________________ ______________________________________________________________________________________

  2. E-mail Address: ____________________________________________________________

  3. Serial number of the international passport (if available): ____________________________________

  4. College, Department, year of studying: ____________________________________________________ ______________________________________________________________________________________

  5. Average rating for the last semester: ______________________________________________________

  6. English skills (estimate your abilities in the 5-grade scale):

    Comprehension

    Speaking

    Reading

    Writing













  7. ^ Other languages skills:

Language

Comprehension

Speaking

Reading

Writing

















































  1. Are you currently involved in any social projects? ___________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

  2. What do you know about volunteer activities? ______________________________________________ ____________________________________________________________________________________________________________________________________________________________________________

  3. Have you ever been involved in the similar projects?_________________________________________ ______________________________________________________________________________________

  4. What do you expect from this program? _______________________________________________ ______________________________________________________________________________________________________________________________________________________________

  5. Where are you going to use the experience you will get during the program?_____________________ ____________________________________________________________________________________________________________________________________________________________________________

  6. Your interests, hobbies__________________________________________________________________

______________________________________________________________________________________

  1. Would you stay abroad for permanent living? Why or why not? _______________________________ ____________________________________________________________________________________________________________________________________________________________________________

  2. ^ Please write down 3 positive and 3 negative features of your character

Positive

Negative






















  1. Please estimate in the 5-grade scale the abilities you are disposed to

    • Responsibility ___

    • Leadership skills ___

    • Communication skills ___

    • Ability to work with people ___

    • Ability to provide activities within a group ___

    • Ability to represent yourself (so called PR) ___

    • Ability to deal with conflicts ___

    • Creativity ___

  2. Information about your family

Member of the Family

(Father, Mother, Siblings)

Address

and Cell Phone Number

Occupation































  1. ^ Specify your computer skills: ____________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

  1. Specify your other skills: ___________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________


  1. Which program would you like to participate in (the program which starts first in Ukraine or in Canada/ ECO or HEALTH )? _______________________________________________________________________________




  1. ^ Please, convince that particularly you have to be chosen a participant of Canada-Ukraine

CORE-HEALTH/ CORE-ECO Program 2012-2013:_________________________________________

_______________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


  1. Please, provide us with a description of a possible project that you would like to conduct during the chosen program (on a separate piece of paper, can be written in Ukrainian).


Thank you for filling the application form!

______________________ ______________________

Date Signature

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