Agape Community Centre Program

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Volunteer Application Form For Agape Community Centre Program.
Applicants Must be 18+ year with present evidence of good Health.

Applicants need to submit:

1. A fully completed application form.
2. Two Typed Letter of recommendation from persons who best know the applicant.

Submit all materials to the ACCP office. Volunteers wishing to travel with minors 8 years of age or older must indicate the names of children on the application form and must sign a separate legal document prior admittance into our volunteer program.

Volunteer application form

First Name: Last Name:
Sex:	Male Female
Date of Birth:	dd/mm/yy
Place of Birth:	City&State
Nationality:
Passport No.
Expires:	dd/mm/yy
Social Security No.
Mailing Address: (Incl Number&Street, City, State, and Country)
Email Address:
Permanent Home Address:

Nearest Relative (Next of Kin)
Address

Current Occupation

Please List all colleges and Universities attended, location of each institution, date of attendance (month/year) and certificates/qualification attained.
Institution	Location	From	To	Award

employment history

Please delineate in descending order (most recent employment first) a menology of your professional experience (if any).
Employment	Location	From	To	Position

Describe any special committee, boards and projects on which you have served.

List your civil and extracurricular activities:

Approximate date of arrival and length of stay:

dd/mm/yy

length

Where did you hear about ACCP?

What is your objective in coming to ACCP; What do you anticipate from the experience?

Program Assignment and Priority Areas of Need (Please indicate areas of interest)

Teaching in primary School
Child care and Outreach/Mobile Clinic
HIV/AIDS Prevention and Counseling
Poverty eradication program

Community Development
Economic Sustaining Agricultural program
Civil Peace Program
Child resettlement Program

What special skills do you possess?
(computer, sports, music etc)

List special medical needs and/ or conditions that ACCP should be aware of: (cancer, diabetes, epilepsy, heart conditions, former strokes, mental illness )

List your current dependents:
Name	Relationship	Age

Will your dependents be traveling with you? if yes, describe what you absolutely need from ACCP in order to support them.

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