<p> Comune di Medolla Application Form for the LEONARDO DA VINCI-Project Please fill in with typewriter. Use the language of the country you chose or English. If there is not enough place use a separate page. Personal details Full name: In case of emergency contact: Street: Zip Code, town: Name: Country: Tel: Tel.: Street: email: Zip Code, town: Fax: Country: Nationality: Date of birth: Sex: Position about the national military/civil service : </p><p>Education/Professional experience Which school education/degree do you have ? Which vocational training do you have? What is your job title? At the moment you are * employed as at * unemployed since Which professional experience do you have ? </p><p>Have you been abroad for longer (exchange, practical training etc.)? </p><p>In which professional field would you like to do the practical training? (Please give examples) 1) </p><p>2) </p><p>3) Foreign languages You can not at all a little bit mediocre/ Fluently communicate in above average English German Italian Hungarian Spanish French ………</p><p>Expectations/Plans Please describe what you expect from a practical training abroad. </p><p>What are your career plans after the project? </p><p>What wishes, hopes and fears do you have concerning this project? </p><p>Why do you think, apart from your professional qualification, you fit into the project? </p><p>We need the following details for your stay abroad Do you smoke? yes no Are you vegetarian? yes no Do you have a driving licence? yes no Are there any activities that you cannot perform due to a handicap (e.g. allergies etc.)? ...... </p><p>Herewith I assure that all given details are true. Autorizzo al trattamento dei dati ai sensi del D.lgs. n°196/03 ______Date, Signature</p><p>ONLY IF REQUIRED BY THE PROJECT CO-ORDINATOR, please enclose in your application copies of certificates and references (no originals). </p>