Personal Details
First Name
Surname
Age
Please select
years old
Gender
Male Female
Mailing Address
Town/City
State/Province
Country of Residence
Zip/Post code
Nationality
Email Address
Questionnaire
What is your education level?
Please select
Degree holder
High School
Pre College/University
Masters
Ph.D
What are you doing at present?
Please select
Working
A student
Taking a gap year
Taking a career break
None of the above
If working, what is the nature of your work and your position?
What is your native language?
*** Other languages you can speak fluently?
...
Please explain briefly your character as best as you can
Please give reasons for wanting to become an Island Volunteer
Have you ever been a member of any other volunteer programs? No Yes
If yes, please give details below
Have you been to asia before? No Yes If so, where?
Are you available to volunteer during the month of February 2009? Yes No
Do you have any special health/dietary requirements we need to be aware of? No Yes
If yes, please give details below
Do you have any criminal convictions? No Yes
If yes, please give date and details of offense
Do you consider yourself to have a disability? No Yes
If yes, please give details below
Do you have any history of mental illness or depression? No Yes
If yes, please give details below
*** Please use this space for any additional information you wish to tell us about
Where did you hear about Island Volunteers?
Google search
Yahoo search
Ask search
Referred by another website (Please specify website)
Referred by a friend
Others (Please specify)