Causeway Programme Partner Request Form
- Please complete ALL sections of the form

ORGANISATION DETAILS
Name:
Address:
Contact Name:
Country:	England Northern Ireland Republic of Ireland Scotland Wales
Telephone:		Fax:
Email:		Web:

NUMBER OF PARTICIPANTS IN THE ACTIVITY
	Male		Female
Age Range	From		To

TYPE OF EXCHANGE
		Bilateral		Multilateral
Preferred First leg Activity
Hosting		Sending		No Preference

PARTNER DETAILS Indicate the type of organisation sought for partnership
Countries sought for transnational co-operation (please number in order of preference: (please number in order of preference - no.1 highest preference)
Rep of Ireland	Northern Ireland	England	Scotland	Wales

Describe your organisation:

Describe activities undertaken by the group:

THE EXCHANGE / ACTIVITY Please describe the young people who will comprise the group and the exchange / activity:

Proposed Dates for the Exchange / activity

Profile of the Group (identify group in terms of the categories below)
		Pupils		Unemployed
		Students		Ethnic Minorities
		Apprentices		Young Workers
		Young People with Special Needs		Other (Specify below)
	Other:

THEMATIC AREA OF ACTIVITY:

I fully acknowledge and agree that the National Agencies for Causeway Programmes will use and distribute the information contained herein, as required, in implementing their partner finding service, and that details will appear on the Causeway website.