To:

I hereby submit application along with required

documentation following the Call of Interest for
APPLICATION
participating in the selection process for taking part
in the second session of the 7-day seminar, which
FAMILY NAME : ..................................................... will take place from 14th to the 19th of November
FIRST NAME : ...................................................... 2016 at the University NIMES, in NIMES,
FATHER'S NAME : ...................................................... FRANCE, within the framework of the project titled
MUS.I.C.D.A.RE - Strategic partnership and
MOTHER'S NAME : ......................................................
training on the use of music as an additive
ADDRESS : ......................................................
treatment modality in the detoxification and
...................................................... rehabilitation processes of individuals suffering from
POSTAL CODE : ................................... drug dependence", which is executed through the
TELEPHONE NR : ................................... National Scholarship Foundation as National
(WORK/HOME) : ................................... Coordination Unit of the Erasmus program+, KA2
E-MAIL : ................................... Adult Education, and especially in the frame of
implementing the related action titled
Transnational Learning/Teaching/ Training
ID DATA
Activities: Intellectual Output 06: 7-day joint staff
ID NR : ................................... training event.
DATE OF ISSUE : ...................................
ISSUED BY : ................................... I hereby submit the following accompanying
documents:
1) ......................................................................
Thessaloniki, .................................. 2016 2) ......................................................................
3) ......................................................................
4) ......................................................................
5) ......................................................................
6) ......................................................................
7) ......................................................................
8) ......................................................................

Signature of applicant

GREEK REPUBLIC
3d H.R. Administration (Macedonia)
G.H.T. G. PAPANIKOLAOU P.H.T.
Organic Unit Psychiatric Hospital of
Thessaloniki