Peace Corps Azerbaijan

Community Economic Development (CED)
Program
Request for a Peace Corps Volunteer
Submit the completed request form to:
Peace Corps Azerbaijan
2c Hasan Aliyev Street
Baku Az1078, Azerbaijan
Or e-mail it to Seymur Yusifli, Program Manager syusifli@az.peacecorps.gov or call to 050 203 32 64,
REQUESTING ORGANIZATION
Name and type of organization (e.g. NGO, governmental, llc, etc):
__________________________________________________________________________________________
__________________________________________________________________________________________
Region: __________________________________________________________________________________
Complete Address:

____________

Office telephone: _______________________________ Email address:___________________
CONTACT INFORMATION
Head of organization (director, manager, branch manager etc)
Name:
Home telephone:

Mobile: _________________________

1. Your organization was established in
2. Total number of staff:

(year)

male

female

3. How many of the staff speaks English? ______________________________________

1

4. Your Organization’s funding source and duration of funding.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
5. Please, briefly describe the Mission Statement or the overall purpose of your organization's activities?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
6. Please, briefly describe the activities that your organization is engaged in (what type of programs you
have, what are the services you provide, who are your beneficiaries, etc)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

7. How will the organization, as well as the community, benefit from collaborating with a Volunteer? Why
do you need a Peace Corps Volunteer to fulfill this role – as opposed to meeting this need via another
source?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________
8. Which area(s) of your work do you think a Volunteer will be most effective in helping you? Describe
how Volunteer will help you with your internal organizational and staff development, with providing
services to your clients and beneficiaries, as well as with working with the community and supporting
a local community’s joint initiatives in economic development.
In other words, provide Volunteer’s brief job

description for Volunteer:

1__________________________________________________________________________
2__________________________________________________________________________
3__________________________________________________________________________
4__________________________________________________________________________
5__________________________________________________________________________

2

6__________________________________________________________________________
7__________________________________________________________________________
8__________________________________________________________________________
9__________________________________________________________________________
10_________________________________________________________________________

9. What are your preferences for Volunteer specialty and/or area of expertise:
1st choice ___________________________________________________
2nd choice____________________________________________________
3rd choice ____________________________________________________
10. Where a computer and Internet access are necessary for the Volunteer’s work, will you be
able to provide it? Yes ____
No____

11. How did you know about PC CED Program and opportunities to have Volunteer? (Please,
tick one)
Newspaper ___

Internet ____

Other PCVs ____

PC staff ____ Other organizations____

Other sources (please specify) ___________________________________________________

Head of applicant organization: Name
Signature
Date

______________________________

Received by PC staff on _________________________________________
Date____________________________________________

3

Sign up to vote on this title
UsefulNot useful