Name and Background First Name * Middle Name/Initial Last Name * Gender Male Female Date of Birth Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Will you be volunteering as part of a pair or group? * No Yes Please list the names of the others. * Contact Information Email Address * Mailing Address City State/Province Country * Postal/ZIP Code Home Phone Work Phone International Code Experience and Other Information Travel Experience * Educational Background * Volunteer Experience * Do you have any medical conditions that we should be aware of? * No Yes Please provide relevant information about your medical requirements. * Do you have any special dietary requirements? * No Yes Please provide relevant dietary requirement information. * What current and past work experience do you have? * What other abilities, special talents, or areas of expertise do you have that you feel would be an asset to this volunteering experience? * Our Chelsea Education Center offers vocational training and workshops in life skills. What are some skills, talents, abilities, topics or areas of expertise/interest you could share with small (or large) groups of children/young adults in either one or multiple sessions? (For example, we’ve had a juggler, a memory champion, a yoga instructor, a knitter, a cheerleader, and someone who discussed The Seven Habits of Highly Effective People.) Please describe. * Skills I could share at Chelsea Education Center * How long do you anticipate volunteering and when would you like to start? * Please select your first two choices for your placement: 1. - None -TeachingAssisting in orphanagesImproving community health and environmental awarenessPerforming school and community maintenanceVillage planting and harvestingCultural exchangeRecording oral historiesProviding medical assistanceWorking with local NGOsChhori [formerly CAPNepal] Internship Position 2. - None -TeachingAssisting in orphanagesImproving community health and environmental awarenessPerforming school and community maintenanceVillage planting and harvestingCultural exchangeRecording oral historiesProviding medical assistanceWorking with local NGOsChhori [formerly CAPNepal] Internship Position What else would you like us to know about you? How did you hear about Volunteer Nepal? * What questions do you have at this time? * Consent to use images * I grant full consent to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images during my volunteering duration. This might include (but is not limited to) the right to use them for fundraising, online publicity, or social media platforms. Agreement * I agree to abide by all the rules and regulations set forth by Volunteer Nepal.
