Tilmelding * Enrolment * Inscription * ECUADOR

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	ECUADOR
	Please fill out in Spanish or English and press the "SEND" button at the bottom of this page. For voluntary social work enrolments send a mail to info@exis.org with your CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.
Dato:
Nombre/First name:
Apellido/Last name:
Dirección/Address:
Country:
Téléfono/Telephone:
E-mail:
Nationality:
Occupation:
Formación/Education:
Edad/Age/Birth date:

Calificaciones/Special qualifications:

How long have you studied Spanish?	years months

Knowledge of other languages?	language years
	language years
	language years

When can you start?

Language course:	I would like to follow spanish lessons during
	2 semenas weeks
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks

Voluntary work:	I would like to work as a volunteer for
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks
	16 semenas weeks

Priorities	Please give 3 priorities:
	Chicos de la Calle
	San José Obrero
	Fundación Queen of Quito
	Women's Jail of the City of Quito
	Children's Hospital "Baca Ortiz"
	Fundación Guayasamín
	Colegio 24 de Mayo
	Educational Unit Mushuc Pacari
	Book bus
	Sinsoluka
	Tropical forest
	Conservation and Community Development project
	Zoo in Quito
	Galapagos, San Cristobal
Do you smoke?	Yes
	No
Do you want EXIS to provide travel insurance?
	Yes
	No
Pårørende der bedes underrettet i tilfælde af sygdom o. lign. Whom to contact in case of illness etc.

Apellido, nombre / Surname, first name

Dirección/Address

Téléfono/Telephone

E-mail:

Eventuelle bemærkninger: Comments:

Hvordan kom du i forbindelse med Exis? How did you find Exis?

		For voluntary social work enrolments, please send by e-mail to info@exis.dk, a CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.