Youth exchange application form, CVS-Bulgaria 2012
CVS Volunteers Application Form
Sending branch: CVS-Bulgaria
1. Name (as in passport):2. Gender:
3. E-mail:
4. Date of birth:
5. Nationality:
6. Present occupation:
7. Address:
8. Contact information:
Home number:
Mobile/work number:
E-mail:
9. Emergency contact person
Name:
Phone number:
E-mail:
10. Do you have any previous experience as a volunteer?
11. Why do you want to take part in a youth exchange?
12. How do you think you can contribute to the Youth exchange?
13. a) What is your Mother language ?
b)What is yourlevel of spoken English ?
(G=good F=fair S=slight)
c) Other languages you speak
(G=good F=fair S=slight) / 1.
2.
14. Do you have any special wishes?
(Please indicate if you are a vegetarian or have any food requirements):
15. Current Health and/or Medication Status:
(Please indicate illness, allergies, disability, mental problems or depressions, etc)
16. Youth exchanges chosen in order of preference:
(Please indicate name, country and dates):
17. Personal motivation: (Pleas answer the following questions for each of your choices)
a. Repeat the name and the country of each exchange
b. Why do you choose this particular exchange?
c. What do you expect from it?
а.
b.
c.
18. Do you already have European Health Insurance Card?
19. How did you hear about CVS?
By completing this form and sending it to CVS-Bulgaria I agree that I fully understand the exchange description and in case I am approved I am willing to participate in all activities.
I also understand that I will get 70% of travel reimbursement only if I keep all my tickets and give them to my leader/CVS-Bulgaria and will receive the reimbursement few months after the exchange only after CVS-Bulgaria receives the reimbursementfrom the host organization.
Name and date:
Cooperation for Voluntary Service - Bulgaria
CVS Bulgaria, 30 Gurgulyat St, floor 1, 1463 Sofia, Bulgaria, Tel/fax: +359 2989 98 46
Email: ,