January 2018 Application
8th January – 9th February 2018
First Name: *
Your answer
Last Name: *
Your answer
Email: *
Your answer
Mobile Number or Skype name: *
Your answer
Date of birth: *
Your answer
Address (with postcode & country): *
Your answer
Others your are applying with:
Your answer
How did you hear about Chalkboard Kenya? *
Your answer
Qualifications: *
Please only provide your highest qualifications.
Your answer
Specialism:
In the past we have had subjects including Nursery, English, Maths, Science, Art, Design, Music, Dance and Physical Education. What subject could you offer the children at the David Moore Academy and what makes you suited to being their teacher? NB: Your subject does not need to be on the list above.
Your answer
Interests:
Please tell us a little bit more about yourself, for example what hobbies or interests do you have? Where else have you travelled in the past?
Your answer
Medical:
Please elaborate below if you have ever suffered from one of the following conditions: Epilepsy, fits or blackouts? Heart, chest or lung problems? Diabetes? Anxiety, depression, eating or psychiatric disorder? Blood disorders? Problems with mobility, lifting or carrying? Do you have asthma that is difficult to control? Any ongoing medical issues? Other medical history which may be relevant?*
Your answer
Do you have any allergies?
If so, please list any inhalers or other medicines that you take:
Your answer
Do you have special dietary requirements?
e.g. vegetarian, vegan, etc...
Your answer
Please explain any issues that may affect your ability to fully participate in all school activities:
Where possible we will always try and cater for every type of volunteer possible
Your answer
Can you swim 50 metres?* *
If your application is successful you will need to pay the $450 AUD deposit within 2 weeks of confirming your place. Please note that this is non-refundable deposit and your place is not secure until it is paid. The balance of your trip is payable 2 months before your departure date.
If you have any further questions, please outline these below and we will endeavour to answer these through email: *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Chalkboard Kenya. Report Abuse - Terms of Service - Additional Terms