G) Have you ever had any personal/professional contact with children/adults with disabilities or fewer opportunities? If yes, please describe it.

G) Have you ever had any personal/professional contact with children/adults with disabilities or fewer opportunities? If yes, please describe it.

H) Have you ever worked with children and/or youth? If yes, please describe it.

PART 4. ADDITIONAL INFORMATION

Are you facing any situation(s) that might make your participation in volunteering activities more difficult (disability, discrimination of any kind, economic difficulties, cultural differences, social difficulties, health problems etc.*)?

*Please take into account, that none of the listed situations can prevent you from taking part in the Program. We need this information to be sure we can prepare and host you properly, not to exclude you from the selection process on that basis.

Do you have any other special needs or medical conditions that the organization should be aware of(diet, allergies, mobility problems, medical treatment, personal support, etc.)?

I hereby authorize Polska Fundacja im. Roberta Schumana to process my personal data included in my application form for the needs of the recruitment process within European Solidarity Corps Programme (in accordance with the Personnel Protection Act of 29.08.1997 no 133 position 883).

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Place and date Signature of the volunteer

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