Tilmelding * Enrolment * Inscription * TANZANIA

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Community Service Programme Tanzania
	Please fill out in English and press the SUBMIT button at the bottom of this page. Please also remember to 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, including a picture - and stating any previous experience.
Date:
First name:	According to passport
Last name:	According to passport
Full address:
Country:
Telephone:
Mobile phone:
E-mail:
Skype:
Nationality:
Passport number:
Education/Profession:
Birth date:

Languages spoken:	language years
	language years
	language years

How long have you studied English?	years months

Work experience:

Do you smoke?	yes
	no


Are you under any medical treatment, if yes, please specify!

Do you have any dietary restrictions ?	yes
	no
If yes, please specify:

Expected arrival date: (When do you want to start the programme?).-	(Day, month, year)

Duration voluntary work:	For how long do you want to start the programme?
	3 weeks summer
	4 weeks
	5 weeks
	6 weeks
	7 weeks
	8 weeks
	9 weeks
	10 weeks
	11 weeks
	12 weeks

Voluntary work choice:	Which type of volunteer work would you like to do? Please number in order of preference (1,2,3) in the first colum and tick off the squares of your choice in the second column.
PREFERENCE:
	A1 Orphanage
	A2 Teaching English
	A3 HIV/Aids Project - Dar Es Salaam, Arusha
	A4 Handicapped Children - Dar Es Salaam
	A5 Woman Project Arusha
	A6 Environment Project, Arusha, Moshi

Travel together?	Do you wish to travel together with a friend?
	yes
	no

	If you want to travel with a friend, please state his/her name:



Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

How did you find Exis?


		Remember to mail the following document : Letter of motivation, stating why you would like to volunteer and if you have any relevant experience or personal interests.