The Rotary Foundation

The Rotary Foundation Cadre Of Techical Advisers

Registration Form

Rotarian Volunteer:If you would like to be considered for service as a volunteer member of The Rotary Foundation Cadre of Technical Advisers (the cadre), please complete this form in full and forward it to your district governor for his/her review and signature.You must also attach an updated C.V. with this application.

Name:
Address:
Phone number(s): / Fax number(s):
E-mail: / Occupation:
Rotary Club: / Rotary District:
Current/past Rotary offices held:

Professional Credentials (specify licenses or degrees held):

Degree/License / Subject Areas / Where Received / Year

Your Skills (professional or amateur):There are seven cadre sectors. Please circle which of the sectorsmay best utilize your skills and note the primary field in which you are qualified to serve as a consultant or trainer.

HEALTH

EDUCATION & LITERACY

AGRICULTURE & FOOD PRODUCTION

WATER, SANITATION & ENVIRONMENT

LOW COST SHELTERS

SMALL BUSINESS & REVOLVING LOANS

FINANCIAL AUDITORS

Please detail all areas of your particular specialization, including professional and educational experience.Please do not include experience as a Rotary Foundation humanitarian grant project contact.

International Experience:

Please include countries in which you have lived.

Please tell us about international projects on which you have worked.

Please tell us about previous volunteer assignments.

Please tell us about countries in which you possess regional or cultural familiarity.

Language Proficiency:

Language / Level / Use the following level codes:
1 = Can understand and respond to questions about personal background and ask directions
2 = Can communicate ideas on non-technical subjects and understand 50% of what native speakers say
3 = Can carry on a conversation on most subjects
4 = Speak and respond almost as well as in native language
5 = Native language

Please sign and date this form to certify the information provided above.

Volunteer / Signature / Date

Please make sure that you have attached a current CVor résumé with the application.

District Governor:As you may know, the Rotary Foundation Cadre of Technical Advisers is a group of Rotarian volunteers who have the responsibility to provide technical expertise to assist Rotarians developing and implementing humanitarian projects. Cadre members can be asked to serve as volunteer site visitors, monitors, liaisons, or auditors to projects worldwide.

Please review the information included on this form.Your responses to the following questions and your signature on the form certify your endorsement of this Rotarian as a potential volunteer.

To the best of your knowledge:

Is this volunteer a Rotarian in good standing? Yes No

Is this volunteer in good professional standing in the community?YesNo

Would this volunteer be a good Rotary ambassador?YesNo

Comments:

District Governor / Signature / Date

Please mail, e-mail or fax this form to

Christian Pepera

Sr. Cadre Coordinator

Rotary International &

The Rotary Foundation

Phone: (847) 866-3357

Fax: (847) 556-2153

Email:

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