APPLICATION Form 2021 - 2022

APPLICATION
FOR ESC PROJECT

COORDINATED BY
We would like to know a bit more about you, your interests, motivation, and needs related to
the ESC project. This application consists of two parts:
1. Questionnaire for the Volunteer (to be completed by you)

2. Questionnaire for the Supporting Organization (to be completed by the representative
of the Supporting Organization)
In our recruitment process, we consider only complete applications. Before you submit the
application, make sure that both the Questionnaire for the Volunteer and the Questionnaire
for the Supporting Organization are filled in.
We are looking forward to receiving your application!
Questionnaire for the Volunteer
YOUR
PHOTO
Dear applicant, please tell us about…
Receiving Organization of the STRIM’s project you are applying for

Fill in only if you know already this info:
Your personal details
Family name
First name
Street address
City Postal code
Country Region
Email Telephone
male/female/other
Date of birth Gender
Place of birth Nationality
Highest level of education

(Mark with an “X”, choose
1 box only) Primary education:
Vocational training:
Secondary education:
Higher education:
Current situation
(Mark with an “X”)
Working
Studying
Unemployed
On training
Long-term unemployed (> 6 months)
Other
Your emergency contact person

Name, surname, and
relation
Address and telephone
Your Supporting Organization

Note: In order to take part in our ESC recruitment you should have your supporting organization. We can consider your
application only if you provide us with the following information:
Name
Street address
PIC/OID number
Postal code Region
City Country
Email Telephone
Website
Background and experience questionnaire
What is your social and
educational background?
Have you ever lived alone?

For how long? How did you find
yourself in that situation?
Have you ever lived abroad??

For how long? How did you find
yourself in that situation?
Have you ever participated in

some European Programme (ex:
Erasmus, Leonardo, Socrates,
Youth in Action, Erasmus+, ESC)
.do you have any
international experiences such
as travels abroad?
Have you already worked with

people from another cultural
background?
What are your language

abilities?
Have you ever had any serious

health problems? Do you have
any chronic diseases (ex.
diabetes, heart disease, asthma,
or other)? Do you regularly take
any prescribed medications?
This info wil help us provide as
good care/conditions as possible
for you
Do you have any special needs

(ex. dietary needs, health care)?
Your honest answer will help us
to be prepared for hosting you.
Have you ever faced some of

the following obstacles or YES NO
challenges in your life so far?
Disability / special needs – e.g. mental (intellectual, cognitive, learning),
physical, sensory, or other disabilities
(Mark with a “X”)
Health problems - e.g. chronic health problems, severe illnesses, or
psychiatric conditions
Educational difficulties - e.g. learning difficulties, early school-leaver, poor

school performance
Cultural differences - e.g. immigrant, refugees or with immigrant or

refugee family background, belonging to a national or ethnic minority
Economic obstacles - e.g. low standard of living, low income, dependence

on the social welfare system, long-term unemployment or poverty, debt
or financial problems
Social obstacles - e.g. facing discrimination because of gender, ethnicity,

religion, sexual orientation
Geographical obstacles - e.g. from remote or rural areas, young people

living on small islands or in peripheral regions, young people from urban
problem zones, young people from less serviced areas (limited public
transport, poor facilities)
if you're working or you have

worked lately, please provide us
with mail contact of your last
employer/supervisor
Your motivation
What does the word “Volunteer”
mean for you?
Have you ever worked as a

volunteer in your country? If so,
please, tell us briefly about your
experiences
How did you get in touch with

the ESC program and why would
you like to take part in it?
Are you studying, working or

doing something else? How will
you combine this with your ESC?
Do you have to leave school/job
for your ESC project?
Which are your fears for your

ESC experience?
What are your expectations

regarding your ESC experience?
What do you know and what do

you think about Non-formal and
Informal Education?
Your interest in the ESC project

Why do you find this project
interesting? Do you have any
experience in similar work?
How do you imagine the work to

be?
How would you like to contribute

to the project? What kind of
activities or ideas would you like to
carry out?
Last not least, please tell us about other important stuff/practicalities
Why did you choose Poland for
your ESC?
What does it mean for you to

live and work abroad?
What does it mean for you to

stay away from everything that
you consider important in your
country (ex. home, family,
friends, passions, school/work)
for a long period of time?
Do you think you can have

problems sharing an apartment
or a room with other people? If
some problems would appear,
how do you think that you would
solve them?
Do you see yourself as a self-

reliant person?
Did you vaccinate against covid-

19? If not, do you consider
getting vaccinated when you
come to Poland?
Do you smoke?
(your answer will not affect our
decision)
Your comments/additional info

If you would you like to add something what you find important but what was not mentioned in this application, please leave a comment:
Thank you for taking the time to complete your part of the
application!
What’s next?
Your supporting organization should fill in the second part of the application: Questionnaire for the Supporting Organization.
Should you have any doubts, questions, comments or uncertainties… feel free to contact us. Our team and our volunteers will
be more than happy to fulfill your curiosities!
Ps. Do not forget to find/like us on Facebook and/or on Instagram: ☺
Questionnaire for the Supporting Organization*

* This part has to be completed by the representative of the Supporting Organization
About the organization
Name:
Phone:
Fax:
Address:
PIC number/ OID number
The sending organization
accreditation (EI) number/ Quality
label:
Contact Person:
Questions
How did you select the volunteer?
What kind of preparation will you

provide the volunteer with?
How do you organize the pre-

departure training for the
volunteers?
Thank you!

APPLICATION Form 2021 - 2022

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APPLICATION

FOR ESC PROJECT

1. Questionnaire for the Volunteer (to be completed by you)

We are looking forward to receiving your application!

Questionnaire for the Volunteer

Dear applicant, please tell us about…

Receiving Organization of the STRIM’s project you are applying for

City Postal code

Place of birth Nationality

Highest level of education

Long-term unemployed (> 6 months)

Your emergency contact person

Address and telephone

Your Supporting Organization

Postal code Region

Have you ever lived alone?

Have you ever lived abroad??

Have you ever participated in

Have you already worked with

What are your language

Have you ever had any serious

Do you have any special needs

Have you ever faced some of

Educational difficulties - e.g. learning difficulties, early school-leaver, poor

Cultural differences - e.g. immigrant, refugees or with immigrant or

Economic obstacles - e.g. low standard of living, low income, dependence

Social obstacles - e.g. facing discrimination because of gender, ethnicity,

Geographical obstacles - e.g. from remote or rural areas, young people

if you're working or you have

Have you ever worked as a

How did you get in touch with

Are you studying, working or

Which are your fears for your

What are your expectations

What do you know and what do

Your interest in the ESC project

How do you imagine the work to

How would you like to contribute

What does it mean for you to

What does it mean for you to

Do you think you can have

Do you see yourself as a self-

Did you vaccinate against covid-

Your comments/additional info

Questionnaire for the Supporting Organization*

What kind of preparation will you

How do you organize the pre-

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