Zambia Exchange, Application Form

Development Education Exchange Visit 2009

Ireland – Zambia

Application Form

Section 1 (to be filled out by applicant)

Name: _______________________________________________________

Contact address: _______________________________________________

Tel: _________________________ Mobile: _______________________

Email: _________________________ Date of Birth: __________________

Why do you want to participate in the exchange visit?

______________________________________________________________

Please describe your youth work experience:

______________________________________________________________

Please describe your experience in the area of development education:

______________________________________________________________

What particular aspects of your organisation’s work might be of interest to Zambian youth workers?

______________________________________________________________

How will you integrate learning from the exchange into your youth organisation’s ongoing work?

______________________________________________________________

Signed: ___________________________ Date: ___________________

Section 2 (to be filled out by the applying organisation)

By signing this section of the application form, the youth organisation commits to participating in the Zambian youth worker’s visit to Ireland during One World Week which is from 14^th- 22^nd November 2009.

NYCI will cover the cost of travel to Zambia, transfers in-country, accommodation and subsistence. Participants and/or their organisations will cover the cost of vaccinations and health/travel insurance (compulsory).

Name of youth organisation: ______________________________________

Address: ______________________________________________________

Tel: _________________________ Email: _______________________

Please give a short profile of your organisation (including type of youth work and main target groups):

______________________________________________________________

Signed: ____________________________ Date: ___________________

(on behalf of the youth organisation)

Return the completed application form to NYCI, 3 Montague Street, Dublin 2, by 5.00pm on Tuesday 28^th of July. Please ensure that section two is filled out and signed by a representative of the youth organisation. Mark the envelope ‘Zambia Exchange 2009’.

By Mieke 11:45 am