application 2012 en
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8/3/2019 Application 2012 En
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The Summer Academy: “Democracy at School”(in cooperation between Ministry of National Education, Poland, the Centre for Education Development, Poland, the European
Wergeland Centre and the Council of Europe)
Warsaw – Sulejówek, Poland
7 - 15 July 2012
APPLICATION FORM
This form must be completed in BLOCK CAPITALS and returned by fax or e-mail before 19 February 2012
to Ms. Stefania Wilkiel with a copy to Ms. Kjersti Toverud Klette.
NB: The paper version of the application form with original stamps and signatures must be posted to Ms. Stefania Wilkiel.
The selected participants will be notified by 15 March 2012 to the CONTACT e-mail address provided in the application.
Stefania WilkielMinistry of National Education
Warsaw, Poland
Fax: +48 22 628 81 36
E-mail: [email protected]
Kjersti KletteThe European Wergeland Centre
Oslo, Norway
Fax: +47 21 08 24 11
E-mail: [email protected]
Country of Applicant Team:
.........................................................................
Team Leader (choose 1 of 3 team members)
Full name:………..………………………………
Tel:………………………………………………
CONTACT e-mail:..............................................
Information about the team
1. School Head: Mr ▢ Ms▢ Year of birth: ................. e-mail:
Surname :....................................................................First Name :...................................................................
Academic background: ……………………………………………………….………………………………
Working language(s)………………………………………………………………………………..…………
A head teacher since: ……………………………………………………………………………..….….……
2. Teacher: Mr ▢ Ms▢ Year of birth: ................. e-mail:
Surname:………………............................................First Name:...................................................................
Academic background: ………………………………………………………………………………………
Working language(s)………………………………………………………………………………..…………
Teacher of (subject): .................................................Years of experience as a teacher: ……........................
3. NGO, teacher trainer or parents’ representative (please underline):
Mr ▢ Ms▢ Year of birth: ................. e-mail:
Surname:....................................................................First Name:....................................................................
Academic background: ………………………………………………………………………………………
Working language(s)………………………………………………………………………………..…………
Position: ...............................................................................................................................................................
Information about the school
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School Name:........................................................................................................................................................
Address : .....................................................................................................................................................
Tel. :....................………… Fax : ...…..……………….……E-mail :...............................................................
Age range of pupils: from: ……………….…... to: ….…….....…........................................................…...…
Type of school: ...................................................................................................................................................
Information abou the organization (parents’ association, NGO, in-service teacher training institution):
Name of organization:...........................................................................................................................................
Address : .....................................................................................................................................................
Tel. :.........................………… Fax : ...…..……………….……E-mail :..........................................................
Type of organisation : ..........................................................................................................................................
Target group of organisation : ……………………………………………………………………………….
The training will be in English and Russian, with translation between the two languages when needed.
The participants should have sufficient knowledge of one or both languages to be able to
participate actively in the training.
I. Please describe your motivation to participate in the Summer Academy (100 words max.):
...
II. Please describe your ideas for implementation and dissemination upon returning to your school
and local community (100 words max.):
...
III. Please describe the strengths of your school/organisation in:
EDC/HRE knowledge (50 words max.):
...
EDC/HRE methods (50 words max.):
...
Community involvement (50 words max.):
...
Implementation of EDC approach (50 words max.):
...
IV. Please describe the challenges your school/organisation face in:
EDC/HRE knowledge (50 words max.):...
EDC/HRE methods (50 words max.):
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...
Community involvement (50 words max.):
...
Implementation of EDC approach (50 words max.):
...
We are aware that the Summer Academy is a one year project that will be carried on in our school in the school
year 2012/2013. That is why we declare our readiness to participate actively in the face to face training and the 10
month online follow-up.
Date: ...…………………………………………
School Head’s Signature: ....…………...….……….
Teacher’s Signature: ....…………………..…………
Partner’s Signature: ....……………………….…….
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