Registered UK Charity No 1105447

Thethi/Vermosh/Lepushe Summer Programmes 2013

July 22nd – August 2nd Thethi

August 5thh – August 23rdVermosh/Lepushe

VOLUNTEER APPLICATION FORM

Thank you for considering volunteering with us for our Summer Programmes 2013. The information in this form is being collected for the purpose of better managing our volunteers. Under the UK Data Protection Act 1998, this information does not go to other third parties and is used strictly for administrative issues within the project.

Note: Volunteers are responsible for all costs - return flight, transfers, room and board (20 Euros) a day including meals.

Sponsored fund raising is also possible to fund yourself – set up a page on the B3P area of the Just Giving Website and get friends and family to sponsor you

Name: / Sex: M/F / Date of Birth:
Home Address: / Telephone No: / Mobile No:
Post Code:
Email Address:
Emergency contact details – please include address and phone numbers (someone we can contact in case of emergency)
Name:
Address:
Telephone No:
Relationship:
How do you see yourself contributing to the Summer Programme? For example teaching English, helping in the classroom, running an extra-curricular activity.
Where did you see or hear about this volunteer opportunity?

References
Please give the names and addresses of two referees . One should be your present employer or, if not employed, your last employer.
If you have not been employed before, you will need to supply referees who are able to comment on your ability to do the job.
1. Title: Name: 2. Title: Name:
Occupation: Occupation:
Address: Address:
Postcode: Postcode:
Telephone No: Telephone No:
Fax No: Fax No:
Email: Email:
Capacity in which known:Capacity in which known:
CRB Certificate Held Yes/No

INTERESTS/QUALIFICATIONS/PERSONAL SKILLS/HOBBIES

Have you visited Albania before or any other Balkan Country?
Relevant travel experience/languages spoken?
Other relevant volunteer work undertaken
Any other relevant qualifications you feel appropriate
Do you have any experience working with children and/or youths?
Are there any other interests or experience that could contribute to the work of the programme?
Do you have any health conditions that would affect your role as volunteer, is there anything we need to do to assist you in your volunteer work? If so, please explain:
Is there anything else you would like to add that you think would be helpful or useful as part of this application?

AVAILABILITY

The Summer Programme is structured into two modules. Indicate your availability in one of the module dates. Arrival dates should be on the Thursday before classes start the following Monday – this allows time for an Orientation in Shkodra and a brief hand-over from the previous team before they leave on the Saturday. *please see note below
The modules are as follows:
July 22nd – August2nd
Dates you are available:
August 5th – August 23rd
Dates you are available:
*The programme obviously works more efficiently if volunteers commit themselves for the full module. Please submit your applicationand we will see how it may be possible to make you part of our project.
Please submit your completed form to: by 1st April 2013
Declaration
I consent to B3P recording and processing the information detailed in this application form. I understand that this information may be used by the charity in pursuance of its business purposes and my consent is conditional upon B3P complying with their obligations under the Data Protection Act 1998.
I can confirm that, to the best of my knowledge, the information provided on this form is correct and gives a fair representation of my qualificationsand employment history.
Signature ______Date ______