FOR EUPA USE ONLY ERASMUS+ PROGRAMME EN

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1 FOR EUPA USE ONLY ERASMUS+ PROGRAMME EN Registration number: MT/15/E+/EVAL- Please fill the form in, print it out, sign it and send it to the EUPA by , post, by private courier service or in person, as indicated in the Call for Applications as published on the EUPA website: EXTERNAL ASSESSOR OF PROJECTS IN THE ERASMUS+ PROGRAMME (E+) 1. PERSONAL DETAILS * COUNTRY / NATIONALITY CODES: AT: Austria BE: Belgium DE: Germany DK: Denmark ES: Spain FR: France FI: Finland GR: Greece UK: United Kingdom IT: Italy IE: Ireland LU: Luxembourg NL: Netherlands SE: Sweden PT: Portugal IS: Iceland LI: Liechtenstein NO: Norway BG: Bulgaria CZ: Czech Republic EE: Estonia CY: Cyprus LV: Latvia LT: Lithuania HU: Hungary MT: Malta PL: Poland RO: Romania SI: Slovenia SK: Slovakia, TR: Turkey OT: Other SURNAME: FIRST NAME: DATE OF BIRTH (DD/MM/YYYY): / / SEX : F : M : NATIONALITY CODE *: ADDRESS: NUMBER, ROAD / STREET: COUNTRY CODE*: POSTAL CODE : TOWN / CITY: MOBILE NUMBER: FAX NUMBER: 1

2 2. MAIN ORGANISATION AT WHICH YOU ARE EMPLOYED EMPLOYED OR SELF-EMPLOYED: IF CHECKED, PLEASE COMPLETE THE FOLLOWING FIELDS. JOB TITLE: ORGANISATION NAME: DEPARTMENT / INSTITUTE NAME: ADDRESS (OF DEPARTMENT/ INSTITUTE): POST BOX: NUMBER, ROAD / STREET: COUNTRY CODE*: POSTAL CODE : TOWN / CITY: TELEPHONE NUMBER: FAX NUMBER: 3. LINGUISTIC SKILLS (PLEASE RATE USING THE COMMON EUROPEAN FRAMEWORK OF REFERENCE FOR LANGUAGES WHICH REFERENCE CAN BE ACCESSED AT: SKILLS-PASSPORT/LANGUAGE-PASSPORT/TEMPLATES-INSTRUCTIONS) EU LANGUAGE CODES: DA: Danish DE: German EL: Greek EN: English ES: Spanish FI: Finnish FR: French IT: Italian NL: Dutch PT: Portuguese SV: Swedish LANGUAGES LANGUAGES LANGUAGE CODES WRITTEN READING CONVER- SATION LANGUAGE 1: LANGUAGE 2: LANGUAGE 3: LANGUAGE 4: LANGUAGE 5: * Level written Very Good means capacity to write project assessments in the language concerned. 2

3 PLEASE FILL IN ONLY SECTIONS THAT ARE RELEVANT TO YOUR EXPERIENCE 4. EXPERIENCE A) ON A SCALE FROM 4 (EXCELLENT) TO 1 (BASIC), INDICATE THE LEVEL OF COMPETENCE YOU HAVE IN RELATION TO THE FOLLOWING FIELDS: LEVEL OF COMPETENCE ERASMUS+ COMENIUS SCHOOL EDUCATION ERASMUS+ ERASMUS HIGHER EDUCATION ERASMUS+ LEONARDO DA VINCI VOCATIONAL EDUCATION AND TRAINING (VET) ERASMUS+ GRUNDTVIG ADULT EDUCATION ERASMUS+ YOUTH IN ACTION FIELD OF YOUTH NON-FORMAL AND INFROMAL LEARNING EUROPE 2020 STRATEGY AND ITS FALGSHIP INITIATIVES NAMELY AGENDA FOR NEW SKILLS AND NEW JOBS AND YOUTH ON THE MOVE EDUCATION AND TRAINING 2020 STRATEGY EUROPEAN YOUTH STRATEGY STRATEGIC FRAMEWORK FOR EUROPEAN COOPERATION IN THE FIELDS OF EDCUATION, TRAINING AND YOUTH RENEWED FRMEWORK FOR EUROPEAN COOPERATION IN THE FIELD OF YOUTH ( ) NATIONAL CURRICULUM FRAMEWORK FOR ALL (2012) FRAMEWORK FOR THE EDUCATION STRATEGY FOR MALTA RESPECT FOR ALL FRAMEWORK A STRATEGIC PLAN FOR THE PREVENTION OF EARLY SCHOOL LEAVING IN MALTA LIFELONG LEARNING STRATEGY 2020 NATIONAL EMPLOYMENT POLICY YOUTH GUARANTEE NATIONAL YOUTH POLICY NATIONAL YOUTH EMPLOYMENT POLICY

4 CO-ORDINATOR PARTNER PARTICPANT CONSULTANT B) I) PLEASE INDICATE IF AND WHEN YOU HAVE HAD ANY PREVIOUS EXPERIENCE WITH THE FORMER GENERATIONS OF EDUCATION PROGRAMMES (EG LIFELONG LEARNING PROGRAMME & YOUTH IN ACTION PROGRAMME) AND ANY EXPERIENCE DURING THE FIRST YEAR OF IMPLEMENTATION OF THE ERASMUS+ PROGRAMME; II) INDICATE YOUR ROLE ACCORDING TO THE INDICATED CAPACITIES; III) SPECIFY THE PROJECT TITLE AND REFERENCE NUMBER OF THE PROJECT IN WHICH YOU WERE INVOLVED. YEAR TITLE OF PROPOSAL REFERENCE NUMBER IF YOU HAVE PREVIOUSLY WORKED AS AN EVALUATOR/ASSESSOR WITHIN THE FORMER GENERATION OF PROGRAMMES PLEASE GIVE DETAILS INCLUDING THE YEAR THE EVALUATION EXERCISE THAT TOOK PLACE AND WHETHER IT WAS CARRIED OUT ON COMMISSION OR NATIONAL LEVEL. LIFELONG LEARNING PROGRAMME YOUTH IN ACTION PROGRAMME 4

5 IF YOU HAVE WORKED AS AN EVALUATOR/ASSESSOR WITHIN THE ERASMUS+ PROGRAMME PLEASE GIVE DETAILS INCLUDING THE EVALUATION EXERCISE THAT TOOK PLACE AND WHETHER IT WAS CARRIED OUT ON COMMISSION OR NATIONAL LEVEL. ERASMUS+ PROGRAMME 5. DECLARATION The undersigned hereby certifies that all the information given in this application is complete and correct to the best of his/her knowledge. The undersigned accepts to provide supporting documents on request. If the information appears to be incorrect or if on request written evidence is not received by the date requested, the EUPA reserves the right to delete the information from its information system. The EUPA cannot be held liable for use of incorrect information obtained via this application form. This application form must be signed and dated. Date: Signature: PLEASE ATTACH EUROPASS CV WITH THE APPLICATION FORM FOR EUPA USE ONLY POST STAMP : / / RECEPTION DATE : / / 5

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