Read the beneath points and sign before sending it to SUSP

Read this before you apply

This form needs to be filled out in English and should give a good impression of who you are, what you like to do and learn. A possible host will decide on the basis of this form if he is interested in offering you a placement. This form is thefirst impressionof you. At the same time, this form should represent you, so you need to fill this in, not somebody else.

You should have practical experience in the sector (all trainees) and an agricultural-horticultural education (non EU). In addition, you should be motivated and thinking off a career in agriculture-horticulture. You should be able to have a conversation in English and be interested in the Netherlands as well.

We strongly discourage couples from applying as placement with one host will be extremely difficult. Any couple that applies should be fully prepared to spend the entire program apart. Inform us honestly if you are a couple so that we can be honest with our hosts.

I agree that I*

Will work on the host’s company to which I am assigned and not at any other company.
Will observe the rules and safety regulations of the host during the training period.
Will not engage in any immoral or illegal practice (f.e. driving under influence, use of drugs, driving without a car insurance or a license, criminal activity etc.) all of which are reasons for immediate expulsion from the program.
Know that if I am unfit or unable to function properly for the training I will be expelled from the program.
Will notify Stichting Uitwisseling of any serious complaints regarding working or living conditions, if I am unable to settle the complaints in private consultation with the host.
Will not operate any motorized vehicle without the consent of the host.
Will return to my own country on completion of the training program.
Will not travel to other countries during the training period without having the appropriate visa (if needed).
Have filled out the application form correctly and honestly by myself.
Will provide the necessary papers now and during the training.
Will attend any obliged meetings.
Will pay the intermediate fee for the Exchange Program.
Am aware that in case I cancel, a cancellation fee plus costs that have already been made will be charged directly to me.
Understand that with all visa and/or work permit applications, the Dutch government can cancel the application at all times.
Have understood the regulations and all of the above.

Signature of applicant Name of applicant: Month, Day, Year:

* If we find out that the reality is different than what you signed for in this paper, sanctions will apply.

Program participation; preferred placement and period
1st choice:	2^nd choice:	3^rd choice:
Length of your training:	When can you start:	When do you need to return:
Partner information
Name organisation: The Saratov State Agrarian University named after N.I. Vavilov	Name contact person: Morozova Olga
Personal details
Family name:	First name(s):
Address:	Postal code:
City:	Province/State:
Country:	Phone number(s):
Email address:	Skype address:
Country of birth:	Place of birth:
Date of birth:	Nationality:
Passport / ID card number:	Date of expiry:
Religion:	Sex: Male Female
Marital status: Married Single Relationship	Children: No Yes
Can you swim? No Yes	Can you cycle? No Yes
Health
Height:	Weight:
Do you smoke? No Yes	Do you drink alcohol? No Yes
Do you have health problems? No Yes, please explain:	Do you have any dietary needs? No Yes, please explain:
Is there anything that may limit your activity and safe execution of those tasks that might be assigned to you? No Yes, please explain:	Have you ever been involved in a farming accident? No Yes, please explain:
Have you ever been treated for or sufferedfrom any psychological problems? No Yes, please explain:	Do you have a history of alcohol- or drugs abuse? No Yes, please explain:
Languages (score your level on a scale from 1 till 10, 10 being excellent, 6 sufficient and 1 no skills)
English Speaking: Writing: Comprehension:	German Speaking: Writing:. Comprehension:	Dutch Speaking: Writing: Comprehension:
What language do you speak in your country?	What other languages do you speak fluently?	Are you taking English lessons? Hrs per week? Since when?
Family information
Father’s occupation:	Mother’s occupation:
Do you have brothers and sisters? No Yes, ages	Do you live on a farm? No Yes
What is the size of the farm?	When do you help in the farm?
Name the major agricultural products /number of animals and size of your family farm:	What were your duties?
Does your family do the general work?	Does your family farm employ workers?
Education
Are you presently attending an agricultural educational institution? No, my present occupation is: Yes, mention the name and contact details (address, phone number, website, email address) of the education institution:	What is the name of your education/ specialty?
Duration of the education?	In which year are you?
Name the supervisor of the educational institution for your training:	What do you hope to learn during your training?
Do you need to do research on a specific subject?	Which educational institutions did you attend? Can you write the name and level?
Driver’s license
Do you have a driver’s license? No Yes	What kind of vehicle does this license allow you to drive?	Since when do you have a driving license?
If you have a license for a tractor, mention brand, model and engine power:	Type of work done with the tractor:	Do you have any driving convictions recorded against your name? No Yes
Various
Do you have friends or relatives living in the Netherlands or surrounding countries? No Yes, please explain.	Did you place a short film about yourself on youtube? No Yes, title:
Did you visit other countries before? No Yes, country, duration and purpose:	What is your nearest Dutch embassy / consulate that issues visas? checkhttp://www.minbuza.nl/en/services/embassies-and-consulates/dutch-embassies-and-consulates-abroad
Work experience
Describe the practical work experience that you gained at home, during training or work. Describe the company and when and for how long you were there. Also describe your tasks, the machinery that you used etc.
Motivation
Describe why you would like to do a training in the Netherlands, and more specifically, in the sectors you would like to do a training in:

Autobiography