Date_________________       

 

Last Name___________________________________ First Name_________________________    M      F

 

Address___________________________________________________________________________________

 

City_______________ Country ____________________________ Zip Code___________________________________

 

Phone (Work)____________________(Home)______________________ Email_________________________

 

Current Occupation and employer ______________________________________________________________

 

If Military, squadron or tenant command _________________________________________________________

 

Will you or have you already made arrangements with a school/Institution/ organization to volunteer?     Yes    No

     If YES, where are you volunteering? Country ______________________Program Location/Dates ____________________

Program Locations     Please indicate all preferences

Marigat        Meru        Sukuma A        Sukuma B        Mpigi

 

Availability                  Please check days and indicate times available

Day:                                                                                                                                        Monday             Tuesday                Wednesday       Thursday               Friday

Time:

Do you wish to participate in any of the excursions and tours listed in the pages?    Yes        No

If Yes which ones? _____________________________/ ____________________________________/ __________________________________

Would you wish to share your cultural experience with participants?    Yes        No

Are you bringing any materials to the work camp?    Yes        No

If Yes, what are you carrying?    ___________________________/ ____________________________/ ________________________________

After the work camp, are you continuing with your stay in the country?     Yes        No

(Please note that the work camp organizers will be be responsible for your safety and expenses after the end of camp) 

Statement

All information in this application is accurate to the best of my knowledge.  I have completed the following forms: Volunteer Application,  I have signed all the forms.  I understand that I must submit a completed application packet, and in some cases, an interview may be required prior to placement in a volunteer position.  I also understand that the references listed at the bottom of this page may be contacted prior to my being placed as a volunteer.  I am aware that, whenever possible, I will wear my volunteer name badge and use the Volunteer Sign In Sheet located in each camp to sign in and out of the camp.  I understand that regular communication with the camp coordinator is important for my safety and that if for some reason I am not able to fulfill my obligation, i will contact the coordinator for advice.

 

Signature ___________________________________________________Date _________________________________

 

In case of emergency notify _____________________________________________Phone ________________________  

To promote volunteerism in our communities, we occasionally use volunteers= names and photos

Please check if we have your permission to use your name and/or photograph.   Name   Photograph  

(Please continue WITH THIS FORM)

 

 

 

References     (Non relative) Please make two copies of this form and have two people write you references to attach to the application.

Name of applicant__________________________________________

 

Address________________________________________

 

City/state/zip/Country____________________________________

 

Relationship to you_______________________________

 

Phone__________________________________________

Languages spoken___________________________________________________________________________

 

Hobbies, Interests___________________________________________________________________________

 

Reason for volunteering in work camp______________________________________________________________________

 

How did you learn about the VFA work camp program?______________________________________________________

 

__________________________________________________________________________________________

TO BE FILLED BY REFEREE

Name of Referee__________________________________________

 

Address________________________________________

 

City/state/zip­____________________________________

 

Relationship to you_______________________________

 

Phone__________________________________________