Subscription EVS MidTerm Evaluation - May 2016

The following form must be filled in by the EVS volunteers hosted in a Romanian project for more than 6 months.

IMPORTANT NOTICE: All lines except the Reference Number are compulsory! When finished, click on the "Done" button and a "Thank you" message will be posted on the screen. If there is no such message, check which compulsory field must be filled in in order to finalize the application process.

Deadline to be filled in: 3rd of May 2016!

MidTerm Evaluation takes place at the middle of the EVS service and it lasts, on average, for three days.

Question Title

* 1. Contact and project data

Name and Surname of Volunteer *

Title of the EVS project the volunteer is involved in *

Name of the hosting (receiving) organization *

Name of the sending organization *

Reference number of the EVS project the volunteer is involved in (ex. RO-21-xxx-2013-Rx)

Country of the sending organization *

Country of the Volunteer *

Volunteer Email Address *

Name and Surname of Project Responsible *

Project Responsible Email Address *

Question Title

* 2. Gender of the volunteer

Male

Female

Question Title

* 3. Period of the volunteer activity (day/month/year)

starts at...

Date

finishes at...

Date

Question Title

* 4. Special needs

Question Title

* 5. I agree that, if I will be selected for participation, I fully understand and I assume the obligation of my active and constant participation during the entire session. Also, I am fully responsible for any damage that I may cause during lodging and I know that in case of incident(s)/damage(s) caused, the hosting/coordinating organisation has the full right to request me for financial reimbursement!

Moreover, in accordance with the content of the "EVS Charter" provisions and "ERASMUS+ EVS Volunteering agreement", document that I declare to read and sign before my enrollment, I am aware of the fact that the receiving organisation is also contractually responsible toward the hosting National Agency for any consequences generated by my behavior during the participation of the EVS session!

I agree