Part I. Personal Information

Summer school - A Holistic approach to workplace health promotion & corporate Wellness - Izola (SLO), 10-15 September 2015

PART I. PERSONAL INFORMATION

Please fill in all the boxes.

First Name:

Family name:

Date of birth:

Place of birth1:

Citizenship:

Passport or ID number:

Native Language:

English level (if it is not your native language):

Current Personal Address2:

Mobile Phone Number3:

Fixed Phone Number:

Email address4:

PART II. EDUCATION AND PROFESSIONAL EXPERIENCE

1 Please insert both the name of city and also the name of the Country of birth. (For instance: Milan, Italy). 2 Please insert your address, ZIP code, City and Country 3 Please insert also the International Country code 4 Please insert the address you usually consult. If you have more than one please insert all of them. 1 Summer school - A Holistic approach to workplace health promotion & corporate Wellness - Izola (SLO), 10-15 September 2015

Current University5:

Current position at the university6:

If you are a postgraduate STUDENT, please insert your exams transcript (with grades)

Previous Universities attended and final grade of degree

Current Professional Experience7

Previous Professional Experience

Other Relevant Experiences

PART III. INFORMATION FOR THE SUMMER SCHOOL

How did you get information about the Summer school? (Please cross the correct information) Email Email sent by your University Conference announcement website Which website?

5 This can be filled in just by those who are still involved in a university environment. Please write the complete full name of the University you are attending. 6 This can be filled in just by those who are still involved in a university environment. For example: student, researcher, assistant professor, professor … 7 This can be filled in just by those who are working at the moment. 2 Summer school - A Holistic approach to workplace health promotion & corporate Wellness - Izola (SLO), 10-15 September 2015

Searching on the web Others

Motivation to attend the Summer school: why are you the right person?

OTHER DOCUMENT REQUIRED Please attach to this application form your personal curriculum vitae.

Place and date...... Signature......

Please send to: [email protected]