Formularz Zgłoszeniowy Do Programu III Szkoła Liderów Polonijnych

Formularz Zgłoszeniowy Do Programu III Szkoła Liderów Polonijnych

4th School for Leaders for the Polish Community

from North America

Application Form

*English or Polish must be used to fill in the form.

* Please answer all the questions and provide all the personal details.

* The form must be scanned and sent by e-mail together with the required attachments.

Personal details:

Full name

Address

Country

Tel. No.

E-mail

Skype No.

Citizenship

Passport No. and date of expiry

Date of birth

Form

  1. A few words about me:

What I do:

My plans for the future are:

In my free time I:

Country/countries I would like to live in and why:

  1. How long have you stayed outside Poland?
  1. Name the institution(s), organisation(s), association(s), club(s) etc. that you work for (What is a given entity engaged in? What is your role and what tasks do you perform? How long have you been cooperating with them?)
  1. Enumerate 2 most important initiatives, projects, events etc. you implemented during the last two years:

Project 1 description:

Team responsible for project implementation and my role:

Results:

Project 2 description:

Team responsible for project implementation and my role:

Results:

  1. What are your plans related to public/social activity for the next two years? What would you like to change or achieve?
  1. Provide a short explanation of your motivation to participate in the 4th edition of the School for Leaders for the Polish Community Abroad (what are your expectations, what skills/knowledge would you like to acquire and how would they help you in conducting your activity in the future?)
  1. How did you find out about the 4th edition of the School for Leaders for the Polish Community Abroad?

via Polish diplomatic posts

via other organisations (which ones?) …………………………………………

via Polish community media (which ones?) ……………………………………..

other (specify)

Language skills:

Enumerate all the languages that you speak and determine your level of proficiency:

1 – I have beginner skills

2 – I can communicate in this language

3 – I am able to participate in lectures and workshops conducted in this language

4 – I am a native speaker of this language

English:

level of proficiency:

Polish:

level of proficiency:

Other languages:

______

Pursuant to the Personal Data Protection Act of August 29, 1997 (consolidated text, Journal of Laws No. 101, item 926, as amended), I consent to the processing of my personal data for the purposes of the School for Leaders recruitment and participating, and agree to their publishing after my participation in the Programme is confirmed

Attachments:

  1. Curriculum Vitae
  2. Candidates are asked to provide 2 recommendation letters containing the following information: full name of the recommending person, name of the institution, position held by the recommending person, telephone number, e-mail and other materials documenting and confirming the information provided in the application form and in the curriculum.
  3. Participation Terms

Full name (manual signature)Place and date

Projekt jest finansowany ze środków Ministerstwa Spraw Zagranicznych.

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