2015 Application Form for eTwinning
Professional Development Workshops
(PDW),
Future Classroom Lab Training (FCL) or
Seminars
Basic data:
Name of applicant institution
Name of applicant
GENERAL INFORMATION – PLEASE READ

Please type your answers.

The programme for the PDW and FCL is generally very full. We ask that you do not bring companions
when attending the PDW OR FCL.

If your application to attend the PDW or FCL is successful you are required to attend all activities for
the duration of the event. You are required to ensure that your travel arrangements allow you to attend
the full event.
ELIGIBILTY CRITERIA

You are registered on www.etwinning.net

You are committed to being involved in an eTwinning project this school year.

Priority will be given to applicants who have not previously attended an eTwinning European
Professional Development Workshop, Seminar or FCL.

Priority will be given to those with a clear dissemination plan for sharing learning outcomes with
colleagues in their school.
PLEASE NOTE THIS APPLICATION FORM SHOULD NOT BE SUBMITTED IN HANDWRITING.
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Acknowledgement of Receipt
This page will be returned to you when we have received and registered your application form. For this purpose,
please complete the section below:
Application for:
Name of applicant institution:
Family and first name of applicant:
Address 1:
Address 2:
Address 3:
We acknowledge receipt of your application:
Ref:
Place:
Date:
Signature:
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A.
Type of visit
The application refers to a :
VISIT BASICS
eTwinning Professional Development Workshop (PDW)
Title of PDW:
Location of PDW:
Dates:
 eTwinning seminar
Title of seminar:
Location of seminar:
Dates:
Future Classroom Lab, Brussels (FCL)
Title of course:
Dates:
 eTwinning Annual Conference
Location:
Dates:

B.
APPLICANT INSTITUTION
Name and address of the institution (if the application is successful, all correspondence related to it will be sent to this
address)
Full legal name of the applicant
institution/organisation:
Address 1
Address 2
Address 3
Telephone number (include area
code):
School Roll Number
E-mail:
Website:
Type of institution
Type of institution:
□ Primary school
□ Secondary school
□ general □ vocational □ technical
□ Establishment for/with learners with special educational needs
□ Other, namely:
Number of staff:
Total :
Female:
Male:
Number of pupils:
Total :
Female:
Male:
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Head of institution (The person who is legally authorised to represent his/her institution and will sign the contract if the
application is successful)
Family and first name:
Mr□
Ms□
Mrs □
Official title:
Previous participation in transnational programmes
Has your school participated in ICT / transnational programmes
e.g. Comenius, East West, Dissolving Boundaries etc.?
□ YES (please fill in the table below)
□ NO
Year
Programme
C.
PARTICIPANT
This section relates to the person undertaking the Workshop.
Participant
Family and first name:
Mr □ Ms□
Mrs □
Date of birth (day, month, year) :
Present position:
Subjects taught (if applicable):
Qualifications and professional
background (please give those
details which are most relevant
to this application):
I am registered with eTwinning
Yes □
No □
I currently have a registered
partnership with eTwinning
Yes □
No □
If yes, please provide a brief
description of your project, and
indicate which countries you are
partnered with
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Have you previously attended an eTwinning Professional
Development Workshop (PDW), Seminar or FCL?
□ YES (please fill in the table below)
□ NO
Year
Details
Private address of Participant (this person will be informed of the result of the selection and may be contacted, if needed,
at his/her private address during school holiday periods)
Address 1
Address 2
Address 3
Country:
Telephone Number:
Home phone number:
Mobile number:
E-mail:
D.
VISIT CONTENT
Please complete this section.
Purpose of the visit
Please tell us (in a maximum of 200 words) why you would like to attend this Workshop, Seminar or FCL and what you
hope to gain from it.
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Actions
We request that all participants engage in promoting the eTwinning programme on their return. List 3 actions you
plan on initiating after the workshop.
How will you involve other colleagues in your school in eTwinning?
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E.
BUDGET
The budget will make a contribution towards travel, subsistence and Professional Development Workshop (PDW), Seminar
or FCL fee (if applicable). Requested funding is based on estimated costs.
Total €
Travel (flights, internal travel etc.)
Travel Insurance
Subsistence (additional days if necessary - please see rates
attached) The subsistence rate offered is 90% of the
maximum daily rate
Workshop fee (this will be covered by the National Support
Service)
Total grant requested
Total grant allowed (to be completed by the NSS)
F.
DECLARATION
This section must be signed and stamped by the person legally authorised to sign on behalf of the applicant
institution - usually the Head of the institution.
We, the undersigned, certify that the information contained in this application is correct to the best of
our knowledge.
Date:
Date:
Place:
Place:
Name and position in capital letters:
Name and position in capital letters:
Signature of the participant:
Signature of the Head of Institution:
Stamp of the institution:
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