1. Surname*:         

First name*:

Gender*:                    Female                                       Male

Address*:

Telephone*:         

E-mail*:

Skype ID:  

2. Birth date*:

Birth place:

Nationality*:

Passport No:

Occupation:

3. Emergency Contact

Name:

Telephone

      (Day)  :  

      (Night): 

Email:

4. Languages*

Speak well:

Speak some:

5. Remarks on health / Special needs / Diet*

6. PROJECT CHOICES ACCORDING TO PREFERENCE*

Location

Periods

Preference* (X)

Fquih ben salah -MOROCCO

from 7th to 21th  August 2014

7. Book another project for me if all above are full:

 YES                              NO

Dates available:                  

Country/region preferred:

8. Past volunteer experiences / General skills (indicate the country, year and type of work)*

9. Why do you wish to take part in a volunteer project?*

.

10. General remarks:

Type of project most preferred (please number according to preference)

Agriculture

Construction

Cultural/arts

Environmental

Renovation

Social

Special needs

Study

Youth/children

11. Where/How did you hear about ACJ?

Web browser (Google, etc.)

The Guardian advert

Family, Friends

Internet link

The Big Issue advert

UNI careers fair

Other (Please state where):