About you Name* Date of birth* Your picture* Email* Skype Phone number Present yourself and your work Your Project Project Title* Project Category*---CapoeiraSkateboardingOther Reference Reference Email Reference Phone Number Project TagsRefugee CampsHost CommunitiesMarginalised CommunitiesSpecial NeedsFree4KidsOther (describe) Other Project Tags Project Photos* Project Pictures* Please include pictures (3mb) along with a description (Where photo was taken, credit, quote, story etc. Project Picture Description* Quote Pictures - Do you have any Quotes, what are people/students saying about your work Quote Picture Descriptions Project Logo * Video Links (if applicable) Video Files Video Links Other Links Facebook Twitter Instagram Website Youtube Other Links What are your students’/ supporters saying about your project? Project Overview What difference do you make? Describe how the project came to life, what is its story, how has it evolved during the time it has been active and what difference on which students/groups does it have. Try to be as precise as possible. Describe the project’s reach and ability to serve the community or target group. What resources do they have and which are they lacking? Which strengths of the project support its goals? Which weaknesses hold it back? • When did your social capoeira project start?* (You must have a current social capoeira project in order to apply for the award.) • Please list the location of your social project. Why did you choose this location? • What is the age range and gender of your students? Where are they from? • Tell us a story about a student or students in your class, what does that story mean to you? • How many advanced students do you have in your class? Does anyone help you teach your class? Do you have assistants or co-trainers?* Project Timeline: Where are we now? Trainers How many trainers? Trainer Name Contact Details How many assistant trainers? Assistant Trainer Name Contact Details Students Number of regular students? Number of female students? Supporters Number of supporters? (CBO/ NGO / Other Supporters) Supporter Details Class Times How many different classes do you teach?* Venue Description Any other relevant information Your continent*---AfricaNorth AmericaOceaniaAntarcticaAsiaEuropeSouth America Your country---AlgeriaAngolaBeninBotswanaBurkinaBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoCongo, Democratic Republic ofDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauIvory CoastKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSouth SudanSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe Your country---AfghanistanBahrainBangladeshBhutanBruneiBurma (Myanmar)CambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussian FederationSaudi ArabiaSingaporeSri LankaSyriaTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemen Your country ---AlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican City Your country---Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited States Your country ---AustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatu Your country---ArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuela City/ Address What do you need help with? Current Income Needs Volunteers Are you looking for volunteers?---Male Trainer / Female TrainerSocial MediaMentorFundraiserMarketingProgramme AssistantOther (describe) Other How many days/ weeks are they required? Have you worked with volunteers before? ---YesNo Please provide a job description What can you offer? Anything else you would like to say? Photograph and Video Disclaimer* I hereby grant permission to C4R for the rights of my images and the sound of my voice as recorded on video without payment or any other consideration. By signing this release, I understand this signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public educational setting. By signing this form I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for educational purposes. *I agree to the termsI disagree to the terms Terms and Conditions • Applicants agree to abide to the eligibility requirements in this document. • The information provided is the applicant’s original work. • The applicant must be available to attend two interviews, either face-to-face or over Skype.I have read and understood the terms and conditions
