VOLUNTEER EXCHANGE FORM
(PLEASE ANSWER ALL QUESTIONS)
e-mail: oikos@oikos.org
fax: 0339-06-5073233
1.
Name: _______________________________________________
Surname: ____________________________________________
Gender: O Male
O Female
Present Address: _____________________________________
Permanent Address:_____________________________
Phone:_______________________________________
2.
Birthdate: ____________________________________
Birthplace:___________________________________________
Nationality: __________________________________________
Passport No.: ________________________________________
Occupation:___________________________________
3. EMERGENCY CONTACT
Name/Surname: _______________________________
Telephone: ___________________________________
4. LANGUAGES:
_________________________ O fluent O good O basic
knowledge
_________________________ O fluent O good O basic
knowledge
_________________________ O fluent O good O basic
knowledge
_________________________ O fluent O good O basic
knowledge
_________________________ O fluent O good O basic
knowledge
5. REMARKS ON HEALTH/SPECIAL NEEDS
___________________________________________________
___________________________________________________
___________________________________________________
6. PAST VOLUNTEER EXPERIENCES (indicate the country, year, and type of
work):
___________________________________________________
___________________________________________________
___________________________________________________
7. GENERAL SKILLS
___________________________________________________
___________________________________________________
___________________________________________________
8. WORKCAMP CHOICES ACCORDING TO PREFERENCE (specify code, name and dates
of the chosen workcamp/s)
Code |
Name |
Dates |
||
_________ |
______________________________ |
_____________ |
||
_________ |
______________________________ |
_____________ |
||
_________ |
______________________________ |
_____________ |
9. BOOK ANOTHER CAMP FOR ME IF ALL ABOVE ARE FULL: O YES O NO
Dates avalaible: ______________
Country/region prefered: _________________________
10. WHY DO YOU WISH TO TAKE PART IN A VOLUNTEER PROJECT?
___________________________________________________
___________________________________________________
Date _______________
Signature____________________