Online Application

Please complete the following online application form. Many thanks for your interest.

Full Name *

Date of Birth

Name & Address of School or
University

Home or Other Contact Address

e-mail*

Contact Telephone*

Are you applying for:
(please tick the group A, B or C or D)

	Group A Cameroon Leaving on 10th September 2009 returning on 10th December 2009 (13 weeks)
	Ghana Leaving on 10th September 2009 returning on 10th December 2009 (13 weeks)
	Group B Cameroon Leaving on 7th January 2010 returning on 7th July 2010 (26 weeks)
	Ghana Leaving on 7th January 2010 returning on 7th July 2010 (26 weeks)
	Group C Cameroon Leaving on 9th September 2010 returning on 9th December 2010 (13 weeks)
	Ghana Leaving on 9th September 2010 returning on 9th December 2010 (13 weeks)
	Group D For two month visits in July / August, or to discuss other possible depature dates.

Qualifications:
Please list your A Level Course / University or Further Education Course/Professional or Trade Qualifications:

Please list the key points which led you to make this application.

10.

Swimming:
Can you swim 100 metres in calm sea water,two metres deep?

A. yes

B. no

11.

Costs:
Do you understand that volunteers whose applications are successful [after interview and receipt of a supportive letter of reference] are expected to pay for the costs of their visit [which will include return air-tickets, all lecture instruction ,in-country transport, food and accommodation] in the following stages:

A. yes

B. no

Group A

June 2009	£1400
August 2009	£1400
TOTAL	£2800

Group B

September 2009

£1750

December 2009

£2150

TOTAL

£3900

Group C

June 2010	£1400
August 2010	£1400
TOTAL	£2800

Group D

Two month visits to Ghana or Cameroon have costs of £1900

Payable one month before departure.

These costs are only subject to changes in the currency rates of exchange and changes in return air flight costs.

Further costs
please understand that, in addtion, Volunteers will be committed to find donations (for the projects in Africa) from their family, friends or other sponsors/donors ? These will be at least £750 for the January departures and at least £500 for the September departures.

NB: We help Volunteers to raise these funds through sponsorship and other donations. We have never failed in 13 years. Costs are the same for each Sub-Saharan project so that volunteers may switch projects without a penalty. Differences in actual costs allow cross project subsidies.

12.

Do you have a full UK driving licence?

A. yes

B. no

13.

Please give the following details of your passport:

Nationality

Passport Number

Date of Issue

Place of Issue

14.

Are you: Smoker?

A. yes

B. no

Vegetarian?

A. yes

B. no

Vegan?

A. yes

B. no

15.

Current Height

Current Weight

16.

Please state any illnesses or accidents that have required overnight hospital visits during the last three years, or any current/permanent medication, treatment or disability assistance. If NONE, then please state so.

17.

Do you suffer from any serious allergies/phobias?

A. yes

B. no

If YES, please describe.


WHEN YOU HAVE COMPLETED THIS FORM YOU SHOULD: 1 - Check you have actually completed all the answers. 2 - Click the Submit button opposite »»»»»»»»»»»
NB: Successful applicants who are called to a UK interview will need to bring a passport size photograph, the registration fee of £30 and a letter of reference supporting the contents of this application form.