Build Homes For Poor Families of Trancoso
1.Personal Information
First name
*
Last name
*
Date of birth
*
Gender
*
Male
Female
Citizenship
*
E-mail
*
Contact phone number
*
Street address
*
Apt #
City
*
State / Province / County
*
Postal / Zip Code
*
Country
*
2. Programme Dates
When would you like to attend this programme
From
*
25/05/2013
01/06/2013
08/06/2013
15/06/2013
22/06/2013
29/06/2013
06/07/2013
13/07/2013
20/07/2013
27/07/2013
03/08/2013
10/08/2013
17/08/2013
24/08/2013
31/08/2013
07/09/2013
14/09/2013
21/09/2013
28/09/2013
05/10/2013
12/10/2013
19/10/2013
26/10/2013
02/11/2013
09/11/2013
16/11/2013
23/11/2013
30/11/2013
07/12/2013
14/12/2013
21/12/2013
To
*
25/05/2013
01/06/2013
08/06/2013
15/06/2013
22/06/2013
29/06/2013
06/07/2013
13/07/2013
20/07/2013
27/07/2013
03/08/2013
10/08/2013
17/08/2013
24/08/2013
31/08/2013
07/09/2013
14/09/2013
21/09/2013
28/09/2013
05/10/2013
12/10/2013
19/10/2013
26/10/2013
02/11/2013
09/11/2013
16/11/2013
23/11/2013
30/11/2013
07/12/2013
14/12/2013
21/12/2013
3. Programme Discounts and Fundraising
3.a) Would you like to share one of our regular rooms with another volunteer and get a US$25/ week discount each? If not, skip to 3.c.
*
Yes
No
3.b) Would you like to share a room with a specific applicant?
Yes
No
Applicant’s name
*
We will try our best to find you a roommate. However, if there are no other applicants looking for a roommate, then a room share will not be possible.
3.c) Do you need assistance raising funds for your programme fees?
*
Yes
No
4. Programme Optionals
4.a) Would you like to enroll in our intensive beginner Portuguese course (10hrs/week for US$150/ week or US$500 for four weeks)?
*
Yes
No
If yes
*
1 week
2 weeks
3 weeks
4 weeks
5. Volunteers Travelling in Groups
Are you travelling with friends or family? If so, please answer 5. a – c. If not, skip to 6.
5. a) How many people are travelling with you?
5. b) Are any of your travel companions also volunteering through Scope? If so, what are their names?
5. c) Do you need us to arrange special housing for your group?
Yes
No
6. Background
6.a) Do you have any special skills you think might benefit the community of Trancoso? If so, what are they?
6.b) Please list any languages you speak.
Beginner
Intermediate
Advanced
Beginner
Intermediate
Advanced
Beginner
Intermediate
Advanced
Beginner
Intermediate
Advanced
Beginner
Intermediate
Advanced
6.c) Tell us about your past experiences that you feel are relevant to this programme.
*
6.d) Use the space below to tell us a little about your hobbies and/or interests when travelling and why you wish to join this programme.
*
6.e) In order to ensure your safety, we need some information about your medical background. Please tell us about any medical conditions you have which might affect your stay in Brazil. Please be as thorough as possible. Your well-being depends on it.
6.f) Do you have any specific dietary requirements (vegetarian, food allergies, etc.)?
7. Where did you first hear about Scope?
*
oneworld365.com
goabroad.com
gapwork.com
igapyear.com
travellersquest.com
Search engine (eg. Google)
Other