INSCRIPTION FORM VOLUNTEERS

Dit formulier kan ingevuld worden in het Nederlands, Engels of Spaans
This form can be filled in Dutch, Spanish or English.

1. PERSONAL DATA

Name*:
Address*:
Date of birth:
E-mail address*:

2. EDUCATION

Recent or actual education:
Specialisation carreer:
Date of graduation:

3. KNOWLEDGE/ SKILLS

English:
Spanish:
Further:

4. EXPERIENCES

Relevant work experiences (internships, voluntary work or paid jobs)

Organization
Function
Responsabilities and tasks

5. VOLUNTEER WORK

Preferences (choose more than one option)

5.1 AREA

Education Turism Pastoral work
Health Sports and recreation Animal protection
Social Work Environment Further:
Cultural Work Rural development

5.2 TARGET GROUP

Children (0-6) Streetchildren Families
Children (6-12) Adults Elderly people
Adolescents (12-18) Mental Disabled Adults    
Mental Disabled Children Physical Disabled Adults Further:
Physical Disabled Children Women

5.3 KIND OF TASKS

Supervising Creative work
Social pedagogic work Diagnostic/ observerving work
Educational work Other:
Organizational

6. HOST FAMILY

Choose most relevant options (more than one options posible)

An own room   Independency
Little children   Possibility to cook
Persons of my age   A lot of house-mates
Pets / animals   Further:

7. INTRODUCTION COURSE

I participate on the introduction course (participation is recommended).

8. LANGUAGE AND CULTURE COURSE

I participate on the Language and culture course.
1st Month (beginners level)   Lessons in a small group
2nd Month (advanced level)   Private lessons

9. FURTHER

Planned date of arrival:
Planned duration of stay:

10. MOTIVATION AND EXPECTATIONS (Resume)

11. QUESTIONS & REMARKS


  

Thank you for your interess!

 

    
         

contact:info@connectiebolivia.nl
Auqisamaña Alto, La Paz
Bolivia
+ 591 701 24 666
Deze pagina is gerealiseerd door: Dibel Soluciones en Tecnologia