Tilmelding * Enrolment * Inscription * TANZANIA

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Community Service Programme Tanzania
	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)

Duration voluntary work:	How long do you want to volunteer?
	3 weeks
	4 weeks
	5 weeks
	6 weeks
	7 weeks
	8 weeks
	9 weeks
	10 weeks
	11 weeks
	12 weeks

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 column and tick off the squares of your choice in the second column.
PREFERENCE:
	1 Orphanage
	2 Agriculture
	3 HIV/Aids Project
	4 Pamoja Project
	5 Medical/Healthcare
	6 Teaching
	7 Training center for teenage girls
	8 Internships


Insurance?	Do you want EXIS to provide travel insurance?
	yes
	no
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:

Safari?	Do you wish to participate in a 5 days safari?
	yes
	Do you wish to participate in a 4 days safari?
	yes
Trekking?	Do you wish to participate in a 6 days Kilimanjaro Trekkingi?
	yes
Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

How did you find Exis?


		Remember to send by e-mail the following document : A CV.andletter of motivation with a picture of yourself, explaining why you are interested in working as a volunteer and stating any previous experience.