AC

AC DR AFRICAN CENTRE FOR DEVELOPMENT &RESEARCH

MEDIA PRISM YOUTH TRAINING

August, 1st to 8th, 2015Brighton, u.k

Application Form

1. Personal Data

Full Name

SexAge

Nationality Street & no.

City, countryPost code

MobilePhone

Personal E-mailDietary requirements

Level of English(Please mark with X) SpeakingReadingWriting

Very goodVery goodVery good

GoodGoodGood

BasicBasicBasic

2. Organisational Data

Name

Street & no.Post code

CityCountry

PhoneFax

WebE-mail

Contact person

Please give a short description of your organisation and its main activities related to intercultural education.

What is your role in the organisation?

3. Experience (Note that the indicated space for submitting the information can and should be exceeded) What kind of experience do you have in working with media as it relates to young people and social Issues? (please list all experiences you consider relevant)

Have you taken any media related training before?

Have you been participating in some international trainings before? (please list all experiences you consider relevant)

4. Media Prism (Note that the indicated space for submitting the information can and should be exceeded!) Please share with us your understanding of Media Analysis:

What are the main competences you would like to gain/improve as a trainer/facilitator of Media Related trainings or as a Media Enthusiast?

What are the 3 most attractive aspects of this training course for you?

1.

2.

3.

How do you plan to use the learning gained during this training course (please be specific)?

Anything else you would like to tell us?

5. Practical issuesIf you are accepted as a participant on this course, will you require assistance in obtaining visa for U.K? If yes, please indicate:

Passport no.Date of issue

Place of issueDate of expiry

6. What is the estimate of your flight to U.K in Euros? :

7. Choose how much Support you will need for your travel in other to be able to attend the training (Standard support is 70% of all travels) : (60% ) ( 70%) (80%) (90%) ?

8. Any other information you will like to share

9. Dietary requirements or any allergies?

Note: for practical purpose, English will be the official language for delivery of the training BUT MOST participants are from non-English speaking countriesPlease return this application form completed NOT LATER than July 13th, 2015 to info@acdr.org.uk

Selected participants will be contacted by 15th of July, 2015