Jeunesse et Reconstruction

Jeunesse et Reconstruction application form Privacy Policy * = required
Please use English
Family Name * First Name * Birthday * Birth place
M/F M F
Nationality * Passport N° /date of issue and expiration If visa needed
Permanent Address * Permanent Address 2
Zip Code * City * Country *
Present address Present address 2
Zip Code City Country
Dates at this address
Email* 1* 2
* Emergency Contact

Handicapped Volunteer? no yes
Comments on any special health and/or dietary needs
4= very well 3 = well 2= some 1= little
Language 1 * 4321 Language 2 4321 Language 3 4321
Occupation How did you learn about us?
Past volunteer experiences/general skills (indicate the country, year and type of work)
Search engine for projects
 1.Please find the country in the search engine
2.Select your project from the list in a new window
3.WriteProject CODE on the application form

Attention When you select a country a new window is opened with the list of projects in that country
PROJECT CHOICES ACCORDING TO YOUR PREFERENCES
Please list at least three project choices in order of priority
IF you want to register for ONLY ONE project enter the SAME project code in all three selections.
Please write the exact project code or the name of country for waiting list
1* 5
2* 6
3*
4 If projects are not in database make registration on the waiting list Insert the name of country in project code field
BOOK ANOTHER PROJECT FOR ME IF ALL ABOVE ARE FULL yes no
your dates of availability To 		Country preferred
WHY DO YOU WANT TO TAKE PART IN A VOLUNTEER PROJECT ?
In the space below please write a short 1-3 paragraph statement of your motivation for the project/s chosen
*
any additional notes on project/s selected
If you want to be placed together with a friend/s, please enter the other name/s:
    * I accept the placement conditions of this organisation and I fully understand and accept my responsibility to obtain health insurance for the duration of my travels
signature Date : 29/07/2010
signature of parent if you are under 18 First Name & Family Name *