FEJS Solidarity Fund Application Form

First name:

Last name:

Address:

Postal code:

City:

Country:

Telephone number:

Mobile number:

Passport number:

Date of birth:

E-mail:

I already participated at following FEJS events:

The reasons I am applying for the FEJS Solidarity Fund financial support:

I am applying for financial support from the FEJS Solidarity Fund to participate at:

Purpose

Amount (in EUR)

Travel costs

(detailed list of used means of transport and costs of them)

Costs of participation

(detailed list of costs at the event)

- participation fee

Other costs

(detailed list of costs)

TOTAL AMOUNT

Amount I wish to have from FEJS Solidarity Fund

Who did I ask for help

Answer

Amount I got (in EUR)

TOTAL AMOUNT

Other comments, wishes and requests:

Date:

Signature of applicant: