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Snorri West Application 2010

Application Deadline March 18, 2010

NOTE: Required fields are marked with an *

Personal Information

Name *
 Surname *
Date of Birth
 Gender *
male  female
Telephone including area code
() 		Fax Number including area code
()
E-mail address *
 Website
Address
  

Health Information

Do you have any special health considerations (allergies, disabilities, etc.)? Please describe.
Are you currently taking any prescribed medication? Please provide the name of the medication and reason why it was prescribed.
Special diet, vegetarian, etc.
Other relevant health information

Contact Person in Iceland in case of Emergency

Name
 Surname
Telephone at work
 Telephone at home

Education

School/College/University/Courses
 Degree/Status if not Graduated

Work Experience

Employer
 Job Description

Languages

Put a number for your ability to speak, write, read and understand. (1) slight (2) fair (3) good (4) excellent

  Speak Write Read Understand
English
Other language
Other language

Hobbies, Interests and Lifestyle

Please describe briefly your hobbies and interests.

Extra Curricular Activities/Community or School Involvement:

Please describe briefly what extra curricular activity you are involved in and why.

Future Plans

Please write a few words about your plans for the future (educational and personal)

Your Expectations

Please describe in your own words what you hope to gain from participating in the Snorri West and what you would be interested in the most while traveling through Manitoba.

Icelandic Emigrant Forefathers

Be as precise as possible

Name and patronymic/surname Emigrated to which part of Canada/Manitoba Year of emigration How related to you?

Known Relatives in New Iceland Area (Manitoba)

Be as precise as possible

Name and patronymic/surname Domicile How related to you?

Your Family Tree

Please put in the names and surnames of your family. Also please include farm names if available. Please mark your emigrant forefather/forefathers with and *. Be as precise as possible.

FN = Full Name
B = Birthdate
BP = Birth place
M = Married
MP = Marriage place
D = death
DP = death place


Snorri West
Participant
FN.
B.
BP.
M.
MP.
D.
DP.
Father
FN.
B.
BP.
M.
MP.
D.
DP.
 Paternal
Grandfather
FN.
B.
BP.
M.
MP.
D.
DP.



Paternal
Grandmother
FN.
B.
BP.
M.
MP.
D.
DP.		 FN.
B.
BP.
M.
MP.
D.
DP.

FN.
B.
BP.
M.
MP.

FN.
B.
BP.
M.
MP.
D.
DP.

FN.
B.
BP.
M.
MP.		 FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.

Mother
FN.
B.
BP.
M.
MP.
D.
DP.
 Maternal
Grandfather
FN.
B.
BP.
M.
MP.
D.
DP.



Maternal
Grandmother
FN.
B.
BP.
M.
MP.
D.
DP.		 FN.
B.
BP.
M.
MP.
D.
DP.

FN.
B.
BP.
M.
MP.

FN.
B.
BP.
M.
MP.
D.
DP.

FN.
B.
BP.
M.
MP.		 FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.



FN.
B.
BP.

FN.
B.
BP.

Please review all of the above information. If all the above information is correct and filled in properly, please press the submit button below.