Tilmelding * Enrolment * Inscription * TANZANIA

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Community Service Programme Ghana
	Please fill out in English and press the SEND button at the bottom of this page. Please also remember to 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, including a picture - and stating any previous experience.
Date:
First name:	According to passport
Last name:	According to passport
Full address:
Country:
Telephone:
Mobile phone:
E-mail:
Skype:
Nationality:
Passport number:
Education/Profession:
Birth date:

Languages spoken:	language years
	language years
	language years

How long have you studied English?	years months

Work experience:

Do you smoke?	yes
	no


Are you under any medical treatment, if yes, please specify!

Do you have any dietary restrictions ?	yes
	no
If yes, please specify:

Expected arrival date: (When do you want to start the programme?).-	(Day, month, year)

Length of stay
	2 weeks
	3 weeks
	4 weeks
	5 weeks
	6 weeks
	7 weeks
	8 weeks
	9 weeks
	10 weeks
	11 weeks
	12 weeks
	longer
Voluntary work choice:	Which type of volunteer work would you like to do? Please number in order of preference (1,2,3) in the first colum and tick off the squares of your choice in the second column.
PREFERENCE:
	Orphanage
	Orphanage on the countryside
	Aids Orphanage
	Teaching
	Teaching in Ho/Ziavi
	Hospitals
	Community Aid
	School painting and construction
	Computer and Internet training

Travel together?	Do you wish to travel together with a friend?
	yes
	no

	If you want to travel with a friend, please state his/her name:

Insurance?	Do you want EXIS to provide travel insurance? (Danish participants only)
	yes
	no

Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

Where did you find Exis?


		Remember to mail the following document to info@exis.dk Letter of motivation, stating why you would like to volunteer and if you have any relevant experiences or personal interests.