Short Term Volunteer Application

Attach Photo of Self

Visions in Action 2710 Ontario Road, N.W. • Washington, D.C. • 20009 Phone 202-625-7402 • Fax 202-588-9344

SHORT TERM PROGRAM APPLICATION □ Mexico □ Tanzania □ Summer □ Winter Please word process, type or print clearly. Name

Social Sec.#/ID# C ity

Address State/Province

Zip/Post Code

Country

Day Phone

Evening Phone

Fax

Email Occupation

Employer

Marital Status

Birthdate

Citizenship

Two Emergency Contacts (name, relation, full address, day and evening phones) 1. 2.

How did you learn of Visions in Action? Education (post secondary-school) School

Location

Major/Degree

Date of Graduation

Work Experience (please attach additional sheets if necessary) Position/Responsibilities

Firm/Organization

Location

Dates

Volunteer and Community Service Experience

International Work, Study, and Travel Purpose

Location

Other Skills and Talents (Artistic, musical, athletic, literary, technical, trade)

Dates

Visions in Action Volunteer Application Page 2

Awards and Accomplishments

Please list names and addresses of two individuals who would enjoy receiving our information. 1. 2.

NAMES OF REFERENCES Please ask two people who are thoroughly familiar with you for personal, academic, or work-related references. Name

Relation to Applicant

Organization/Company

1. Telephone Number: 2. Telephone Number:

Before You Mail in Your Application… Please take the time to fill in this checklist to ensure that your application is complete. I have included:  This signed, completed application  A non-refundable application fee of US$45.00  Four passport size photographs  A photocopy of the page in my passport which includes my photo  Two letters of reference in separate, sealed envelopes  Résumé I hereby affirm that all of the information supplied herein is true and correct. Signature

Please return to:

Date

Visions in Action 2710 Ontario Road, N.W. Washington, D.C. 20009, USA Telephone: 202-625-7402

Visions in Action Volunteer Application Page 3

Visions in Action Development Volunteer Programs in Africa Letter of Recommendation

Application due date_________________

Name of applicant____________________________Country of interest______________________ Name of reference_________________________________________________________________ Occupation____________________________Employer___________________________________ Length and nature of relationship with applicant__________________________________________ To the Recommender: The applicant has applied for a volunteer position in a developing country with Visions in Action. The applicant, if accepted, will be placed with a nonprofit development organization for a 6 or 12month period. On a separate sheet of paper, preferably letterhead, please comment on the applicant's ability to successfully carry out such a volunteer assignment, and based on your prior experience evaluate the applicant in the following four areas: 1) Teamwork 3) Cross-cultural adjustment 2) Leadership qualities and initiative 4) Concern for social justice If the applicant is applying for Burkina Faso or Mexico and you are familiar with the applicant's language abilities, please note their proficiency level here: (French for Burkina Faso and Spanish for Mexico) Proficiency: Excellent Good Average Fair Poor Please return your recommendation to the applicant in a sealed envelope, signed and dated on the back. -------------------------------------------------------------------------------------------------------------------------------

Visions in Action Development Volunteer Programs in Africa Letter of Recommendation

Application due date_________________

Name of applicant____________________________Country of interest______________________ Name of reference_________________________________________________________________ Occupation____________________________Employer___________________________________ Length and nature of relationship with applicant__________________________________________ To the Recommender: The applicant has applied for a volunteer position in a developing country with Visions in Action. The applicant, if accepted, will be placed with a nonprofit development organization for a 6 or 12month period. On a separate sheet of paper, preferably letterhead, please comment on the applicant's ability to successfully carry out such a volunteer assignment, and based on your prior experience evaluate the applicant in the following four areas: 1) Teamwork 3) Cross-cultural adjustment 2) Leadership qualities and initiative 4) Concern for social justice If the applicant is applying for Burkina Faso or Mexico and you are familiar with the applicant's language abilities, please note their proficiency level here: (French for Burkina Faso and Spanish for Mexico) Proficiency: Excellent Good Average Fair Poor Please return your recommendation to the applicant in a sealed envelope, signed and dated on the back.