* Required

* 1. Country where you teach:

* 2. Surname (family name):
e.g. Smith, García, Kowalski, Silva, Müller...

* 3. First Name (given name):
e.g. Diana, Albert, Maria, Susanna, John, Laura...

* 4. Email address:
Please make sure you write your email address correctly.

* 5. City where you teach:

* 6. Name of your school:

* 7. Postal address of your school.
Please write the full postal address of your school. For example: European Schoolnet, Rue de Treves 61, 1040, Brussels, Belgium

* 8. What subjects do you teach?

* 9. Age of your students:
Select all the relevant ages.

* 10. Please select Yes, No, or Not Applicable (N/A):

  Yes No N/A
You are confident that you and your pupils have sufficient English knowledge to participate in the Triseum Pilot Activities.
Your school meets the minimum technical requirements for ARTé: Mecenas v2.1: Windows 7 SP1, Mac OS 10 Sierra, or Mac OS X Yosemite Version 10.10.2. CPU – Intel Celeron 1.87GHz. 4GB (RAM) of memory, Intel HD Graphics 4000, 800 MB Disk Space.
Your school meets the minimum technical requirements for Variant: Limits v1.1: Operating System (OS) Windows 7.1 +, Mac OS 10 Sierra, CPU Intel® Celeron® 1.87GHz. 4GB (RAM) of memory, Intel HD Graphics 4000, 5 GB Disk Space.

* 11. Describe your previous experience of participation in European / national-level education projects (your role, tasks and achievements).
If this would be your first participation in an international project, explain why should you be selected to take part in the Triseum Pilot project.

* 12. Terms and conditions

  Yes No
I understand that the selection of Triseum Pilot teachers will be carried out by European Schoolnet (EUN), and approved by national authorities if relevant, and results will be announced via email by 22 September 2017.
The school management board has agreed to support my work in the Triseum Pilot, if selected.
I understand that selected teachers will not receive any payment for their participation in the Triseum Pilot.
A Memorandum of Understanding will be signed between EUN and each successful Triseum Pilot teacher which will cover key tasks and responsibilities.
I understand that, if selected, I must attend the two Triseum Pilot workshops in Brussels on 17-19 November 2017 and 16-18 February 2018.
I understand that EUN keeps the right to cancel completely or modify any of the conditions related to this call. No obligation will arise under this call until a Memorandum of Understanding has been signed by both EUN and the selected teacher.
I understand that to process my application, collection and storage of personal data (name, surname, email address) is necessary. Access to this information is strictly limited to EUN Partnership AISBL and will only be used for this specific purpose.
I understand that, if selected to participate in the Triseum Pilot, my email account will be shared with Triseum LLC. Triseum LLC is authorised to use my contact information for the sole purpose of creating the Triseum game account.