Passport photo

APPLICATION FORM
Name and Dates of the Event: __________________________________________________
(each event must be provided a full application dossier)
1. Personal information
Title:
(Mr, Ms, Rev., etc.)

Family/surname:
(as in passport)

First/given name/ (s):

(as in passport)

Maiden name:
(if applicable)

Gender: female male

Civil status: single married

other (please specify):

Date of birth:
(day/month/year)

Town and country of birth:

(as in passport)

Nationality:
(as in passport)

Full name of passport country:

Passport number:

Place of issue:
(city, country)

Date of issue:
(day/month/year)

Valid until:
(day/month/year)

Faith community:
(if Christian, full name of national church/diocese/denomination)
2. Contact information
Street address:

Postal/Zip code:
(if applicable)

City:

State (if applicable):

Country:

Telephone:
(country code, area code, #)

Fax:
(country code, area code, #)

E-mail address:

Alternative e-mail address:

3. Language (NB: the event language is English, no interpretation provided.)

Mother tongue:
Self-assessment of English language skills (use the underlined codes) *
Basic user: A1 (beginner) or A2 (elementary) Independent user: B1 (intermediate) or B2 (upper intermediate)
Proficient user C1 (advanced) or C2 (proficiency)
*according to Common European Framework for Reference of Languages (CEFR)
Skills:

Understanding
Listening

Reading

Speaking
Spoken
interaction

Writing

Spoken
production

English

4. Education
a. Full title of the upper secondary school certificate:

Country of issue:

Date of issue:

b. Full title of university degree (s), if applicable:

Full name of the issuing university(ies):

Country of issue:

Date of issue:

5. Other information
Current profession:
Ecumenical experience:

Other relevant information that should be taken into account in considering your application:

How did you find out about the event?

I testify that the information I have given in this form is true and accurate and that, if admitted, I agree to abide by
the conditions governing the World Council of Churches.
Date:

Signature:

FINANCIAL PLEDGE/ASSISTANCE REQUEST FORM

Financial assistance towards course fees is provided according to the following criteria:
o
o
o
o
o

Financial assistance is considered to an applicant only when this form is fully filled in.
Financial assistance is always partial, each applicant needs to make a pledge for financial contribution
i.e. a promise to give money.
Return travel expenses to and from the event site, all personal travel related expenses (such as
passport, visas(s), vaccination(s), travel insurance, etc.) are the responsibility of the accepted
participant.
Board and lodging expenses en route or at the event site before and after the official dates of the
event are the responsibility of the accepted participant.
Priority is given to the candidates seeking for financial assistance for the first time.

Family/surname:
(as in passport)
First name (s):
(as in passport)
Name and Dates of the Event:
I apply for financial assistance and pledge to contribute the following amount towards the event costs:

Currency: _______________
* please, use the official currency abbreviations

Total amount of my pledge: _______________________

(i.e. CHF / EUR / USD, etc.)

Example:
Currency:* EUR

Total amount of my pledge: 1000.00

I attach the original supporting document(s) if my pledge includes funds from a third party
(i.e. by any organization, church, foundation, government, parish, private service provider, school, university,
family, friends(s), etc.)

I confirm that I am unable to cover all the event costs and therefore am in need of partial financial assistance. I
commit myself to continue to search for further funds in order to increase my pledge and engage to inform the
World Council of Churches of any developments.
I agree that I will be made responsible to reimburse the financial assistance, should I not complete the event
programme I may be accepted.
Date:

Signature: