PLEASE SEND THIS FORM BACK WITH A MOTIVATION LETTER FOR EACH PROJECT YOU ARE APPLYING FOR TO info@union-forum.org

EVS Volunteer Exchange Form

Name/Nom:

Firstname/Prénom:

Sexe: Male □ Female □

Birthdate/Date de naissance:

Age:

Birthplace/Lieu de naissance:

Nationality/Nationalité:

Passport N°:

Numéro de sécurité sociale/ Social Security Number:

Personal Address/Adresse Actuelle:

Tel: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Personne à prévenir en cas d'urgence/Emergency contact:

Tel: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

I apply for the following projects: code, title/ Je vous adresse une demande pour les projets suivants: code, titre : 1......................................................................................................................... 2......................................................................................................................... 3.........................................................................................................................

What period would you like to volunteer (please give earliest and latest dates) and for how long? / Quand voudrais-tu participer à un projet de volontariat, pour combien de temps?

Do you have any health problems (e.g. allergies)? / As-tu des problèmes de santé (ex: allergies)? Special needs / besoins spéciaux (ex: végétarien, besoins physiques):

Present occupation/ Activité actuelle: □ Profession/ activité professionelle: ___________________________________ □ Student/ étudiant □ unemployed/ en recherche d'emploi □ Others/Autres : __________________________________________________ What is your study level?/Quel est votre niveau d'étude?

Do you have driver's licence?/ As-tu le permis de conduire? □ Yes / Oui □ No / Non

Language skills / compétences linguistiques: Speak well/ parle bien:_______________________ Speak some/ parle un peu:_________________________________

Have you ever done any volunteer work? What kind?/ Quelle est ton expérience de volontariat? □ none/aucune □ workcamps/chantiers □ group activities/activités de groupe □ animation/project leading □ other/autres: ______________ Why do you wish to take part in a long term voluntary project?/ Pourquoi veux-tu participer à un projet de volontariat? _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Where do you see your strengths for doing this service?/ Quelles sont tes forces pour participer à ce service? __________________________________________________________________________ __________________________________________________________________________ What are your expectations?/ Quelles sont tes attentes? __________________________________________________________________________ __________________________________________________________________________ What are your fears?/ Quelles sont tes craintes? __________________________________________________________________________ __________________________________________________________________________ Other comments/ autres commentaires:

PLEASE SEND THIS FORM BACK WITH A MOTIVATION LETTER FOR EACH PROJECT YOU ARE APPLYING FOR TO info@union-forum.org

Date: 2015-12-18; view: 964

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