Agape's Summer Scholarship - 2017

AGAPE'S SUMMER SCHOLARSHIP - 2017

I am applying for:  International theological camp  International workcamp camp  International political camp  Work camp (period of volunteer work)

I will arrive on: I will leave on:

Name: Surname:

Gender: M F Birth date (you have to be eighteen to participate): Birth place: Nationality:

Street address: c/o: City: Country: State/Province: Telephone: Mobile: Fax: Email:

Occupation: Spoken languages:  English  French  Italian  Spanish

I am Vegetarian: Allergies: Notes:

For the participation fess I need a:  Full scholarship, ??? euros (I can't pay anything)  2/3 Scholarship, ??? euros (I will pay ???)  1/3 Scholarship, ??? euros (I will pay ???)  No Scholarship, 0 euros (I will pay ???)

For my travel cost I will need a:  Full Scholarship, my full travel cost will be:......  Partial Scholarship, I can contribute towards the const of travel and I am asking Agape for:......  I have no need of a travel Scholarship Organization that supports your application:

Name: …...... Address: …...... City: …...... ZIP Code: …...... Country:...... Telephone: …...... Mobile: …...... Fax: …...... Email: …......

Please give the name and the address of a person (religious/community leader, professor, supervisor, activist) who can support your application. Please do not forget to send a letter of support by e-mail to: [email protected]

Supporter: …...... Address: …...... City: …...... ZIP Code: …...... Country:...... Telephone: …...... Mobile: …...... Fax: …...... Email: …......

How will you and you community work benefit attending the camp?

How will you and your communuty work contribute to the camp?

Please list your volunteer and/or professional activities/affiliations

Notice pursuant to Art. 13 of Law D.lgs of June 30th, 2003 no.196. You are hereby informed by Agape Centro Ecumenico that the data you provide to this organisation will be stored and processed for organizational and administrative purposes linked to your registration for the relevant camp/weekend/or schools programme organised by Agape, or for your registation as a guest on its premises. Furthermore, this data may be used for promotional purposes, or to send you pertinent information on our activities and services.Your details may be stored in printed and/or electronic form in such as way as to ensure its confidentiality and will be available only to those staff directly in charge of processing this information.Your personal details must be provided in order for your to take part in the activities of Agape, or to register as a guest on its premises. Those failing to provide such details will not be able to register. You are also informed of your ri ghts under Art.7 of Law d.lgs 196 2003 including, but not limited to, your entitlement to access your personal data, to correct, update, or delete it, or to request that your personal details not be used for promotional purposes. You may exercise this right by writing to the Data Manager, at [email protected] or to our postal address Agape Centro Ecumenico Bg. Agape, 1 10060, Prali (TO), Italy. Having duly read this notice, the participant.