Africa Trust - Application Form

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:

	Cameroon (13 weeks)
	Ghana (13 weeks)
	Morocco (13 weeks)
	Cameroon (26 weeks)
	Ghana (26 weeks)
	Morroco (26 weeks)
	For two month visits in July /August, or to discuss other possible lengths of visit.

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.

Do you have a full UK driving licence?

A. yes

B. no

12.

Please give the following details of your passport:

Nationality

Passport Number

Date of Issue

Place of Issue

13.

Are you: Smoker?

A. yes

B. no

Vegetarian?

A. yes

B. no

Vegan?

A. yes

B. no

14.

Current Height

Current Weight

15.

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.

16.

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.