Complete
this form to apply for your volunteer project and proceed to reserve your
spot. If you have questions contact Peter Fiorentino at (202)
719-0283 or send an
email to:
PFiorentino43@msn.com
First Name
Middle Name
Last Name
Birthday
Gender
Female
Male
MySpace Page (Optional)
Facebook Profile (Optional)
CONTACT INFORMATION:
Email Address
Confirm Email
Address
Street Address
City / Town
State /
Province / County
Post / Zip Code
Country
Phone (Work)
Phone (Home)
HEALTH AND SAFETY:
Your safety is important to us. In case of an emergency, who should
we contact?
(Please include name, relationship, and appropriate phone numbers)
Do you have any
dietary or health conditions we should know about? VOLUNTEER
PLACEMENTS: *Teaching
-Grades K-6 -Grades 7-12 -University Profs
*Orphanage
Assistance
*Environmental
Conservation
*Wildlife
Conservation
*Community Development
SELECT
YOUR FIRST CHOICE
PROJECT
If you are
teaching, what type of school would you prefer?
Public School
Private School
In the case
that we can't place you in your first choice project we ask that you supply
us with two backups.
First Backup
Second
Backup
How
many weeks do you plan to volunteer for?
When
do you plan to start volunteering?
Would
you like to enroll in supplemental language classes?
Yes
No
How many weeks
of language classes?
What is the
highest level of education you've achieved?
Why are you
interested in the projects you selected? (100 words or less)
How did you
hear about SDPUS?
Include
questions or comments in the space below.
CONFIRMATION:
How are you
planning to pay the $500 deposit fee?
PayPal
Check