Questionaire for Prospective Volunteers

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Placement
Questionaire

QUESTIONAIRE FOR PROSPECTIVE VOLUNTEERS

Please complete in full to assist us with your placement in a volunteer position.

General Information

Full Name

E-Mail

Occupation

Birth Date :
(mm/dd/yyyy)

Sex

Marital Status

Phone

Fax

Address

Country

About the Program / Assignment

Select your preferred placement area : (It is possible that your preferred area choice may not be available at this time; if it is not, we will find you another assignment that matches your interests and experience as closely as possible.) Describe the type of work you want to do in your volunteer assignment. List any relevant work experience or skills you may have. List any previous volunteer work you have done. Tell us about any experience you have coping with other cultures and language difficulties, or how your think you will deal with such obstacles in your volunteer assignment.
Rate your Spanish proficiency on a scale of 1 to 5: (1 indicates no knowledge of Spanish, 5 is fluency)
Do you prefer to work alone, or in a group setting?	Group Alone
Total Number of Days (min. 14):
Start Date :	(mm/dd/yyyy)
End Date :	(mm/dd/yyyy)
Host Family Request :	Yes No

If �Yes� to the above, please supply details:

Passport Information

Number:		Place:
Date of Issue (mm/dd/yyyy)		Expiry Date (mm/dd/yyyy)

Additional Information

Any medical condition / history / disability / dietary requirements
that we should be aware of?

Name and contact details of a person to contact in case of an emergency.

Please tell us when and how you discovered Incas del Per�?