Tilmelding * Enrolment * Inscription * ECUADOR

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	ECUADOR
	Please fill out in Spanish or English and press the "SUBMIT" button at the bottom of this page. For voluntary social work enrolments 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 and stating any previous experience.
Dato:
Nombre/First name:
Apellido/Last name:
Dirección/Address:
Country:
Téléfono/Telephone:
E-mail:
Nationality:
Occupation:
Formación/Education:
Edad/Age/Birth date:

Calificaciones/Special qualifications:

How long have you studied Spanish?	years months

Knowledge of other languages?	language years
	language years
	language years

When can you start?

Language course:	I would like to follow spanish lessons during
	2 semenas weeks
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks

Voluntary work:	I would like to work as a volunteer for
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks
	16 semenas weeks

Priorities	Please give 3 priorities:
	A1 Chicos de la Calle
	A2 San José Obrero
	A3 Fundación Queen of Quito
	A4 Women's Jail of the City of Quito
	A5 Children's Hospital "Baca Ortiz"
	A6 Fundación Guayasamín
	A7 Colegio 24 de Mayo
	A8 Educational Unit Mushuc Pacari
	A9 Sinsoluka
	A10 Reserva Bellavista, or other reservations
	A11 Galapagos, San Cristobal

Do you smoke?	Yes
	No

Pårørende der bedes underrettet i tilfælde af sygdom o. lign. Who to contact in case of illness etc.

Apellido, nombre / Surname, first name

Dirección/Address

Téléfono/Telephone

E-mail:

Eventuelle bemærkninger: Comments:

Hvordan kom du i forbindelse med Exis? How did you find Exis?

		For voluntary social work enrolments please add a CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.