Surname(s) (as in passport)

First name(s) (as in passport)

Street address

Postal code

Town		Country
Please provide at least one fax number or one e-mail address where you can be reached for quick communications.

Telephone (countrycode/areacode/number)

Home

Office

Telefax (countrycode/areacode/number)

Home

Office

Email

Gender

Male        Female

Marital Status

Single      Married

Indigenous Person

Yes

If yes, please specify:

Date of birth (day/month/year)

Confession

Name of church in which you are a member

Profession or Occupation (if student, which field)

Nationality (country issuing your passport)

Passport number

Date and place of issue

Passport valid until

Mother tongue

Other languages spoken and understood fluently

Special needs (physical disability or medical condition)

Please answer the following questions on a separate sheet:

1. Why are you interested in the ecumenical movement / being a steward for the Central Committee?
2. Have you been a steward before (local, regional, global)?
3. Have you ever been involved in youth work at a local, national or international level?
4. What are the main concerns facing young people in your country?
5. How can you further ecumenical (youth) work in your local or national situation?
6. Describe yourself in five lines.

I confirm I will cover my travel expenses fully, if selected.

I confirm I will cover fully my travel expenses, if selected

or

I apply for travel subsidy.

If selected, my cash contribution towards travel expenses is US$ ______

a letter of recommendation.

a copy of passport or identity card or birth certificate

I confirm that I will stay for the full duration of the Stewards Programme.

I understand that the WCC will provide board, lodging and pocket money for this period only. Any other expenses, including passport and visa(s) costs, local/national travel related expenses such as vaccinations, luggage insurance or telecommunication costs, are my own responsibility.