Visions in Action
AttachPhoto of Self
2710 Ontario Road, N.W. • Washington, D.C. • 20009Phone 202-625-7402 • Fax 202-588-9344
V
OLUNTEER
A
PPLICATION
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6 Months
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12 Months Program Departure Date____________
Please word process, type or print clearly.
NameSocial Sec.#/ID#
Current Address
CityState/ProvinceZip/Post CodeCountr yDay PhoneEveningPhoneFaxEmail
Permanent Address
CityState/ProvinceZip/Post CodeCountr yDay PhoneEveningPhoneFaxOccupationEmployer Marital StatusBirth dateCitizenshipTwo Emergency Contacts (name, relation, full address, day and evening phones)1.2.
For which country program(s) are you applying?
Please rank your choices (First=1, Last=8) ___Mexico (6 mo)___South Africa (6 mo)___Tanzania (6 mo)___Uganda (6 mo) ___Mexico (12 mo)___South Africa (12 mo)___Tanzania (12 mo)___Uganda (12 mo)
Please circle your location preference for
Tanzania
(Moshi or Arusha).
For which positions are you applying?
Please rank your choices (First=1, Last=8) ___Project Manager___Program Assistant___Health Professional ___Public Health Educator___Youth Group Coordinator___Researcher ___Community Development Worker___Journalist___Other______________
Please rank the sectors that interest you.
Please rank your choices (First=1, Last=20) ___Agriculture___Food/Nutrition___Natural Sciences ___Appropriate Technology___Family Planning___Refugees/Relief ___Children (Ages 1-12)___Health___Small Business ___Communications___Housing___Social Sciences ___Democratization___Human Rights/Law___Women ___Education___Mentally Disabled___Youth (Ages 13-20)
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