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Application Form

1. Last name: _________________________ First name: _____________________________
2. Home address, telephone number & e-mail address: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
3. Nationality: _____________________________
Marital status: ______________________
4. Date of birth: ___________________________
Place of birth: _______________________
5. Present Position/Title: _______________________________________________________
Since (month & year): _________________________________________________________
6. Business address, telephone number & e-mail address: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
7. Previous Positions (most recent first; use separate sheet if necessary):
Dates 
Position  
Organization and address
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
8. Education and Professional Training:
University and location
Date degree awarded
Subjects studied
Bachelor’s:
____________________________________________________________________________
Master’s:
____________________________________________________________________________
Ph.D.:
____________________________________________________________________________
J. D.:
____________________________________________________________________________
Other:
____________________________________________________________________________
9. Proficiency in foreign languages:

Fluent
Good
Fair
1) Language: ________________________________________________________________
2) Language: ________________________________________________________________
3) Other languages spoken or written: ____________________________________________________________________________
10. Have you ever visited any of the EU Institutions? ____________________________________________________________________________
Name and location of Institution: ____________________________________________________________________________
Date and reason for visit: ____________________________________________________________________________
11. Have you visited any EU member countries within the last five years?
Country
Reason for visit
Date
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
12. If accepted into the European Union Visitors Program, I am willing to allow my name to be used in future to promote this program.

___I agree

___I do not agree

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