Application for New Cycles Project
10 August 2017
Section 1: Personal Information
Please fill in the blanks
1. I, Mr. / Miss / Mrs. *
2. Nickname
Date of Birth
MM
/
DD
/
YYYY
Age
years
Medical Conditions / Allergies
Religion
Dietary
restrictions:
Clear selection
Others
3. Current Grade
School
District
Province
4. Current Address No
Moo
Sub-District
District
Province
Postal Code
Home Phone
Cellphone
E-mail
5. How did you learn about the project? (you may choose more than one answer)
Internet, please indicate the website
Others
6. Have you previously participated in similar projects?
Clear selection
Yes, which project? / No, because
7. Special talents / abilities
Section 2: Questionnaire
(You may wish to design or decorate the application form as you deem appropriate)
1. Introduce yourself in your own style
2. Please share your experience and understanding of slum communities
3. What are your opinions on “poverty cycle”?
Submit
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