SCI Volunteer Exchange Form
Sending branch : SVIT-Ukraine
Please use capital letters and fill in english
1. 2. 3. M
5. 6.
7.
8.a. 8.b
8.c
9. 10.
11.
b.
13.a. b.
b. -
15.
2. Code Name Dates
3.Code Name Dates
4. Code Name Dates
5. Code Name Dates
6. Code Name Dates
16. 1.
4. a. b.
5. a. b.
6. a. b.
1. Surname/ Family name
2. First name
3. Sex (M=male;F=female)
4. a) Date of birth (day, month, year)
b) Age
5. Nationality
6. Present occupation (if student, state subject)
7. Address where we can send the camp information to.
Put street, postal code, town and country!
8. a) home number
b) mobile / work number
c) email address : please use capital letters
9. Emergency contact / name of the contact person
10. Passport number
11. Give details of your voluntary / community work experience including workcamps (both in SCI and outside of it)
12. a) Why do you want to do a workcamp with SCI? (for extra motivation, use a separate sheet of paper)
b) What do you think can you contribute to the workcamp as a volunteer?
13. a) Mother tongue
b) Other languages you speak. Put language: G for good, F for fair, S for slight. (e.g. “English – G, Spanish – S” if you speak English well and a bit of Spanish.)
14. a) Special wishes, e.g. vegetarian/muslim/jewish food etc, if you want to take a child with you, …
b) Any serious accidents, illnesses, disabilities, allergies. SCI does not discriminate volunteers with a serious physical or mental condition.
15. Workcamps chosen in order of preference.
Put camp code, name and dates e.g.
BE-VIA 6.2 De Wroeter 12/7-26/7
16. Motivation : answer the following questions for each of your choices.
a) Repeat the name of each camp
b) Why do you choose this particular workcamp? What do you expect from it?