VOLUNTER’S APPLICATION FORM

European Voluntary Service

INFORMATION ABOUT THE PROJECT

Hosting organisation:	Katolicki Ruch Antynarkotyczny KARAN
Duration in months:	01/10/2014 – 30/06/2015 / 9 months
Venue:	Wrocław/Poland

VOLUNTER’S APPLICATION FORM

Photo

Background info

Family name:

First name:

Address:

Phone:

Fax:

E-mail:

Skype:

Birth date:

Sex:

Male

Female

Nationality:

Contact person in case of emergency:

Phone:

Address:

Your present occupation:

Studying

Where? Since when?

Working

Where? Position? Since?

Unemployed

Since when?

Other

Your education:

primary education

vocational training

secondary education

higher education

Institution:

Additional education (like training courses, internship, apprenticeship, etc):

Do you have driver's licence?

Yes

No

Language skills:

Native language:

Fluent

Good

Enough

Poor

English

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Do feel identified with any of the categories mentioned below?

Social obstacles: young people facing discrimination because of gender, ethnicity, religion, sexual orientation, disability, etc.; young people with limited social skills or anti-social or risky sexual behaviours; young people in a precarious situation; (ex-)offenders, (ex-)drug or alcohol abusers; young and/or single parents; orphans; young people from broken families.

Economic obstacles: young people with a low standard of living, low income, dependence on social welfare system; in long-term unemployment or poverty; young people who are homeless, young people in debt or with financial problems.

Disability: young people with mental (intellectual, cognitive, learning), physical, sensory or other disabilities.

Educational difficulties: young people with learning difficulties; early school-leavers and school dropouts; lower qualified persons; young people with poor school performance.

Cultural differences: young immigrants or refugees or descendants from immigrant or refugee families; young people belonging to a national or ethnic minority; young people with linguistic adaptation and cultural inclusion problems.

Health problems: young people with chronic health problems, severe illnesses or psychiatric conditions; young people with mental health problems.

Geographical obstacles: young people from remote or rural areas; young people living on small islands or peripheral regions; young people from urban problem zones; young people from less serviced areas (limited public transport, poor facilities, abandoned villages).

Please explain:

Personal information

Name some features of your character:

Strengths:

  Weaknesses:

Your hobbies, interests, favourite activities:

Which problems do you think you may encounter while staying for a long period in another country?

European Voluntary Service
List your main reasons for decision to take part in EVS project:
Have you done any voluntary activities before? If yes, what these activities were and when?
What knowledge, skills you hope to gain during your voluntary service abroad?
How do you think you’d use your knowledge, skills and experience obtained during voluntary service abroad when you come back?
Describe your intercultural experience. Have you participated in any international project? Which countries have you visited and for how long? Have you encountered any problems?
How could you contribute (skills, knowledge, personally…) to the hosting project?
Do you have any allergies?	Yes	No
If yes, which:
Do you have any health problems: Yes No If yes, which:   Imagine that you are going to live in a multicultural environment with people having different habits, religions and ways of living. Do you have any religious, cultural, daily practices that need special consideration?
Will you implement any follow up initiative after coming back?	Yes	No
Please explain, what activities you would like to implement:

Feel free to give any extra information about yourself and your participation in the EVS: (f.e. how long you know the sending organisation, specific goals you want to achieve with the help of this project or your features, expectations that you want host organisation to know about).
I declare that all information is correct: Yes No I add my CV to this application: Yes No
Date		Signature:
Sending organization's remarks:
NGO “YEC “Fialta”, Minsk, Belarus Contact person: Alisa Karpovich Email: [e-mail] [phone]

Дата добавления: 2015-10-29