Personal Information
  Name:
Email:
Street Address:
City:
State/Province:
Country:
Date of Birth:
Sex: Male
Female
Work Experience
  Employer 1:
Location:
Job title:
Dates employed to
Employer 2:
Location:
Job title:
Dates employed: to


Please tell us about your hobbies, likes and dislikes (to help us make an appropriate placement).



Please could you tell us what inspired you to become a volunteer in Nepal?



Have had a criminal conviction in last five years? Yes No

If so please state your conviction.



Would You object to a possible police check being done? (This is due to type of work being under taken i.e. teaching or care Yes No

Do you have any Medical issues that require special attention i.e. diabetic-fridge needed? Yes No

Please provide Name and address of two referees (not family members) i.e. university lecturer or employer.

Name (reference 1)


Address


Name (reference 2)


Address


Choose your preferred placement date. If any of these dates are not suitable, please mention it to us. We could possibly arrange another date suitable for you.



How Many months would like to stay? (maximum 5 months in one calendar year)



Placement Details
  Do you object sharing accommodation with another volunteer? Yes No
Eating habbits: Vegetarian Non-vegetarian Vegan
Preferred location (1st choice):
Preferred location (2nd choice):
Preferred placement (1st choice):
Preferred placement (2nd choice):
Preferred placement (3rd choice):
Note: Although we will try our utmost to meet your every need, this may not always be possible because of the third world country you are coming to with the obvious problems that carries. If you have another field that you wish to volunteer in, please let us know as we may have contact for such a placement.



You will be notified of your acceptance status within fifteen days of our receiving your application (subject to references being acceptable).