APPLICATION FORM: COURSE FOR EUROPEAN EDUCATORS

EXETER: SUNDAY 05 APRIL-FRIDAY 17 APRIL 2015

Please complete this form and return it to Discover@International-Study-Programmes.org. uk if you definitely intend to attend the course
because you have been informed that you will receive an Erasmus+ grant (or you will pay with your own funds or other funding)

I will definitely attend this course:

X
Date:
FIRST NAME: CIOCAN SURNAME: PETRICA DORIN Sex:
M
X
F 
COUNTRY: ROMANIA NATIONALITY: ROMANIAN MOTHER TONGUE: ROMANIAN

DATE OF BIRTH 22 FEBRUARY REGION SUCEAVA COUNTY PASSPORT OR IDENTITY CARD NUMBER: SV 961996

HOME ADDRESS : AUREL VLAICU STREET, NR. 1A, VAMA, POST CODE: 727590, SUCEAVA COUNTY

Town & Postcode: VAMA, 727590

Telephone: 0230239076 Mobile: +40744558774 E-mail: pit_c00@yahoo.com

NAME & ADDRESS OF SCHOOL: NATIONAL COLLEGE “ DRAGOS VODA” LICEULUI STREET NR. 3

Telephone: 0230312337 Fax: 0230312337 Email: dragos.voda@clicknet.ro

PRESENT (TEACHING) POSITION: TEACHER

WHICH SUBJECTS DO YOU TEACH? HISTORY- PHILOSOPHY

DO YOU TEACH ENGLISH? YES  NO X FOR HOW MANY YEAR HAVE YOU TAUGHT ENGLISH?

AGE OF PUPILS TO WHOM YOU TEACH ENGLISH:

AGE OF PUPILS ATTENDING YOUR SCHOOL: 11-18 YEARS

PLEASE WRITE A FEW LINES ABOUT YOUR SCHOOL/PLACE OF WORK: National College “Dragos-Voda”, founded in 1907, is a public preuniversitary
institution, containing a number of 24 classes, high-school level ( IX-XII ), 4 specializations : mathemathics-informatics, filology, natural sciences, and social
sciences. In 2013-2014, the college had 718 students attending, and a number of 47 teachers, 21 first grade, 11 second grade, 8 begginers.

HAVE YOU ATTENDED A TEACHERS’ COURSE IN BRITAIN BEFORE? YES  NO x IF YES, PLEASE STATE WHERE AND WHEN

ARE YOU RECEIVING AN ERASMUS+ GRANT? YES NO x 

HOW DID YOU HEAR ABOUT THIS COURSE? From internet sources.

WHAT QUALIFICATIONS DO YOU HAVE IN ENGLISH (eg. University Degree/Teaching Diploma)?

WHAT IS YOUR LEVEL OF ENGLISH? LOWER INTERMEDIATE:  INTERMEDIATE:  UPPER INTERMEDIATE:  ADVANCED:

OR: A1:  A2:  B1:  B2:  C1: x C2: 

ON THE 2 DAY VISITS TO SCHOOLS: DO YOU WANT TO VISIT: A PRIMARY SCHOOL (AGES 4 – 11): € OR A SECONDARY SCHOOL AGES (11 – 18): x
Please tick (√) 1 box if you wish to visit one type of school on both days. Please tick (√) 2 boxes if you wish to visit 2 different types of school

PERSONAL REMARKS (eg. Health, Diet, etc):

WILL YOU BE ARRIVING BY CAR AND USING YOUR CAR DURING THE COURSE? YES  NO x DO YOU SMOKE? YES  NO x
(A) HOST FAMILY ACCOMMODATION (Bedrooms are always single unless you ask to share a bedroom with a named participant)
I WOULD LIKE TO BE THE ONLY PERSON OF MY MOTHER TONGUE IN MY HOST FAMILY 
I DO NOT MIND IF THERE IS ANOTHER GUEST OF MY MOTHER TONGUE IN MY HOST FAMILY 
I WOULD PREFER TO SHARE A BEDROOM WITH ANOTHER PARTICIPANT (please give name) 
I WOULD PREFER TO HAVE A SINGLE BEDROOM IN THE SAME FAMILY AS ANOTHER PARTICIPANT 
If you wish to share with a particular participant, please state name:

NB: Whilst every effort will be made to accommodate participants as requested, this cannot be guaranteed
DO YOU WISH TO STAY EXTRA NIGHT(S) WITH YOUR HOST FAMILY? NO  YES  NUMBER OF NIGHTS  DATES:
See ‘Additional Nights’ on page 1 of Information Sheet
(B) I SHALL BE MAKING MY OWN ARRANGEMENTS FOR ACCOMMODATION x
WHAT ARE YOUR EXPECTATIONS FROM THIS COURSE?

I do hope that i will improve my English skills as well as my teaching skills too.I’m sure that i will spend a great time meeting new people and that i will learn
lot more about English culture and civilization.