Formulario

Please, fill out this form in English.
First Name/s
Family name/s
Gender	Male       Female
Place of Birth
Date of Birth (DD/MM/YYYY)	/  /
Nationality
Address
Country
E-mail
Passport Number
Telephone and time to contact you
Personal Information
What's your current working situation?	(Select one) Working Unemployed Studying Other
What is the highest level of education you have completed?	(Select one) Primary Secondary University Bachelor University Master
Education and/or vocational training (with dates)
Have you got any previous voluntary work experience? Describe with dates
Language Abilities	Mother Tongue Fluent Good Basic Dutch English French Spanish German Other:
Other activities, skills, hobbies, sports, music...
Do you have a driving license?	Yes       No
Do you have special needs that would need to be taken in account? (dietary needs, problems of mobility, health care, …)
Do you consider yourself as a person with less opportunities ? living in an isolated place / having a difficult economic situation
Can you give us information about a contact person in case of emergency?
Specific Information
Why do you want to do an EVS? Describe your motivation for participation at the EVS, what do you hope to gain from it
When would you like to do the EVS?
How long do you want to do it?
Where do you want to go? Why?
Is there some place you don’t want to go?
Do you have a preference for one type of organization?	National Agency         University Youth organization     Cultural centre
Do you have a preference for one theme?	Gender                  Animals anti-discrimination  Children Art     Development Cooperation Environment          Health Religion                 Sports
Which of the activities do you like more?
Which kind of activities don’t you like to do?
Atmosphere
What do you think about sharing a room? Do you have the experience of living with others?
Who would you like to work with?	I don't care         By yourself With children      Young people With old people
How do you feel about working closely with others, and to take responsibilities?
How do you feel about living in city?
Or in an isolated village?
How did you know about the EVS and the CCH?
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