| 1. |
Full Name * |
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2. |
Date of Birth |
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3. |
Name &
Address of School or
University |
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4. |
Home or Other Contact Address |
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5. |
e-mail* |
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6. |
Contact Telephone* |
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7. |
Are
you applying for:
(please tick the group A, B or C or D)
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8. |
Qualifications:
Please list your A Level Course / University or
Further Education Course/Professional or Trade Qualifications:
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9. |
Please list the key points
which led you to make this application. |
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| 10. |
Swimming:
Can you swim 100 metres in calm sea water,two metres
deep? |
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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:
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|
| |
Group A
September 2008 |
£1600 |
December 2008 |
£2000 |
TOTAL |
£3600 |
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Group B
June 2009 |
£1300 |
August 2009 |
£1300 |
TOTAL |
£2600 |
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| |
Group C
September 2009 |
£1600 |
December 2009 |
£2000 |
TOTAL |
£3600 |
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Group D
Two month visits to Ghana or Cameroon have costs of £1900
Payable one month before departure.
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These costs are only subject to changes in the currency rates of exchange and changes in return air flight costs.
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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? |
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13. |
Please
give the following details of your passport: |
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Nationality |
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Passport
Number |
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Date of
Issue |
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Place of
Issue |
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14. |
Are you: Smoker? |
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Vegetarian? |
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Vegan? |
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15. |
Current
Height |
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Current
Weight |
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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. |
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17. |
Do you
suffer from any serious allergies/phobias? |
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If YES,
please describe. |
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