The SummerAcademy: “Democracy at School”
(in cooperation between Ministry of National Education, Poland, the Centre for Education Development, Poland, the European Wergeland Centre and the Council of Europe)
Warsaw – Sulejówek, Poland
7 - 15 July 2012
APPLICATION FORM
This form must be completed in BLOCK CAPITALS and returned by fax or e-mail before 19 February 2012
to Ms. Stefania Wilkiel with a copy to Ms. Kjersti Toverud Klette.
NB: The paper version of the application form with original stamps and signatures must be posted to Ms. Stefania Wilkiel.
The selected participants will be notified by 15 March 2012 to the CONTACT e-mail address provided in the application.
Stefania WilkielMinistry of National Education
Warsaw, Poland
Fax: +48 22628 81 36
E-mail: / Kjersti Klette
The European Wergeland Centre
Oslo, Norway
Fax: +47 21 08 24 11
E-mail:
Country of Applicant Team:
...... / Team Leader(choose 1 of 3 team members)
Full name:………..………………………………
Tel:………………………………………………
CONTACT e-mail:......
Information about the team
- School Head: Mr ▢ Ms ▢ Year of birth: ...... e-mail:
Academic background: ……………………………………………………….………………………………
Working language(s)………………………………………………………………………………..…………
A head teacher since: ……………………………………………………………………………..….….……
- Teacher: Mr ▢ Ms ▢ Year of birth: ...... e-mail:
Academic background: ………………………………………………………………………………………
Working language(s)………………………………………………………………………………..…………
Teacher of (subject): ...... Years of experience as a teacher: ……......
- NGO, teacher trainer or parents’ representative (please underline):
Academic background: ………………………………………………………………………………………
Working language(s)………………………………………………………………………………..…………
Position: ......
Information about the school
School Name:......Address: ......
Tel. :...... ………… Fax : ...…..……………….……E-mail :......
Age range of pupils: from: ……………….…... to: ….…….....…...... …...…
Type of school: ......
Information abou the organization(parents’ association, NGO, in-service teacher training institution):
Name of organization:......Address: ......
Tel. :...... ………… Fax : ...…..……………….……E-mail :......
Type of organisation : ......
Target group of organisation: ……………………………………………………………………………….
The training will be in English and Russian, with translation between the two languages when needed. The participants should have sufficient knowledge of one or both languages to be able to participate actively in the training.
I. Please describe your motivation to participate in the Summer Academy (100 words max.):
...
II. Please describe your ideas for implementation and dissemination upon returning to your school and local community (100 words max.):
...
III. Please describethe strengths of your school/organisation in:
EDC/HRE knowledge (50 words max.):
...
EDC/HRE methods (50 words max.):
...
Community involvement (50 words max.):
...
Implementation of EDC approach (50 words max.):
...
IV. Please describe the challenges your school/organisation face in:
EDC/HRE knowledge (50 words max.):
...
EDC/HRE methods (50 words max.):
...
Community involvement (50 words max.):
...
Implementation of EDC approach (50 words max.):
...
We are aware that the SummerAcademy is a one year project that will be carried on in our school in the school year 2012/2013. That is why we declare our readiness to participate actively in the face to face training and the 10 month online follow-up.
Date: ...…………………………………………
School Head’s Signature: ....…………...….……….
Teacher’s Signature: ....…………………..…………
Partner’s Signature: ....……………………….…….
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