RurACT Model Access Form

1. First Name and Surname *

2. Year of Birth *

3. Gender *
M F 

Please leave this field empty.

4. Locality *

5. Ethnicity

6. Occupation *
-- Please Select (required) --NGO leaderNGO memberInitiative group leaderInitiative group memberMayorMayoralty employeeLocal councilorDistrict councilorDistrict council employeeHead of public institutionPublic institution employeeEntrepreneurEmployee in private companyUnemployedRetiredCollege/university studentSchool student

-- Please Select (optional) --NGO leaderNGO memberInitiative group leaderInitiative group memberMayorMayoralty employeeLocal councilorDistrict councilorDistrict council employeeHead of public institutionPublic institution employeeEntrepreneurEmployee in private companyUnemployedRetiredCollege/university studentSchool student

-- Please Select (optional) --NGO leaderNGO memberInitiative group leaderInitiative group memberMayorMayoralty employeeLocal councilorDistrict councilorDistrict council employeeHead of public institutionPublic institution employeeEntrepreneurEmployee in private companyUnemployedRetiredCollege/university studentSchool student

7. Have you previously benefited from IRI services/projects? *
Yes No 

8. What is your motivation to participate in this course? *