APPLICATION FORM FOR SCI MEDIUM AND LONG TERM VOLUNTEERS
Mail to: SCI-IVS USA, 205 North Plain road, Great Barrington, MA 01230
With your check for the applicable fee.
Names of Projects you are applying for:
First choice:______________________________________
Second choice:_____________________________________
Third choice:______________________________________
1) Your Name: _____________________________________
2) Permanent Home Address: ________________________
City:__________________________Country:____________
Telephone:_______________________________
Present Address: __________________________________
City:_________________________ Country: ___________
Telephone:_______________________________
3) Nationality: ____________ Date of Birth:________ Sex:_____
Town of birth: ______________ Country of birth: ______________
4) Date you are available for voluntary service
From ____/____/____ to ____/____/____ and
How long do you want to serve? (minimum) ___________(maximum)__________
5) How do you like to spend your free
time:
6) Fields of interest: (Please circle the ones you are interested in.)
Third World issues Sex roles Disabled people Anti-racism/fascism Elderly people Young people Ecology/Environment Children Other__________
7) Experience with SCI (workcamps, branch
activities, working-groups, coordinating camps):
8) Why do you want to be an M/LTV with
SCI?
9) Present occupation/studies/ training
scheme following or completed:
10) Previous work experience (paid and/or
voluntary work):
11) Languages:
Please write how well you can speak, read or write English and
add other languages you have in the boxes on the left.
Speak Read Write
English
_______
_______
12) Skills you would like to mention
(such as practical, artistic, domestic, intellectual, etc.
driving license)
13) Three references from workcamp
coordinators, earlier employers, (not
relatives)
Contact Name: ______________________________ Address:
Organization:
______________________________
Contact Name: ______________________________ Address:
Organization:
______________________________
Contact Name: ______________________________ Address:
Organization:
______________________________
14) Any serious accidents, illnesses,
handicaps, allergies, mental
problems or depressions? Specify:
15) Are you already insured? If so please
give details:
16) Experiences with communities (or
other long-term projects):
17) Explain as fully as possible why you
are applying for this post and what you envisage both
contributing and learning from the experience:
18) Would it be possible for you to visit the project before hand?
19) How did you hear about the post?
20) Space for anything you would like to
add about yourself:
If you need more space for certain questions, please continue here and indicate which question you are answering. Thank you.