Application Form for non-UK Participants
HOW TO USE THIS FORM
All questions should be answered and returned to Tim Yearsley by e-mail to
The deadline for applications is 23June 2018in order to ensure that there is enough time to request and receive your reference and allow you to go ahead and make travel arrangements. We will endeavour to process your application as soon as possible and will notify you by e-mail within 14 days whether you have been accepted on to the programme and will instruct you regarding payment (€125).
PERSONAL INFORMATION
Name / Date of birthEmail / Mobile number
Gender / Marital status
Nationality / Navigator ministry
HEALTH
This information will be held in strict confidence but we do require you to disclose any condition that may have a bearing on your suitability for involvement with us.
Do you have any health problems of which we ought to be aware (including any food or medication allergies, diabetes, epilepsy and heart conditions)?
If yes, please explain: ______
Do you have any disabilities of which we ought to be aware (including sight, hearing, mobility, special educational needs, or mental health)?
If yes, please explain: ______
Have you ever suffered from depression, eating disorders, extreme homesickness, anxiety attacks, claustrophobia or any other phobia or mental health issue that might impact your time on ESTP?
If yes, please give details: ______
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EMERGENCY CONTACT DETAILS
Please give details of two people we an contact in case of an emergency
Name / Relationship to you / Telephone (with country code)First
Second
REFEREE DETAILS
We also require a personal reference to be provided. Ideally this should be your Navigator Representative but if not then a Church leader, tutor, work supervisor or someone responsible who knows you well will suffice. Please complete their details below and we will contact them direct to ask them if they have any reservations about you participating in this programme.
Referee Name: ______
Relationship to you: ______
E-mail address:______
Telephone:______
Signed: ______Date: ______
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