Complete this form to apply for your volunteer project and proceed to reserve your placement. If you have questions call us (USA) 215-780-1845 or send us an email volunteers@abroaderview.org

Last Name:
First Name:
 
Emergency Contact
Name:
Address 1:
Emergency Contact Address:
City:
State/Province:
Zip Code:
Country:
Telephone # :
 
Current Address
Address 1: 
Address 2: 
City: 
State/Province: 
Zip Code: 
Country: 
Telephone # : 
How long will you be at your current address?  / /
 
Email:
Sex:
Date of Birth: / /
Place of Birth:
Nationality: 
Passport Number:
Destination:
Project:
Arrival Date: / /
Departure Date: / /

Please describe your professional skills, training, language skills:

Please describe your educational background including certificates etc
 
What is your native language?
Do you speak another language?

Have you ever lived or traveled abroad? Please describe in detail:

Please tell us about your hobbies, interests, extra-curricular activites.
Which volunteer program are you interested in and why?

If given a preference which type of accommodation do you prefer:

homestay
local guesthouse
at the orphanage (not always applicable)
Do you have any special dietary requirements?
Do you have any allergies or medical conditions?
 
Please indicate your relevant skills and interest.
Working with children/youth
Working with disabled
Working with elderly
Computers 		Teaching
Sports
Music
Manual skills (please specify)
Others (please specify)

How did you hear about us? Please specify the keywords you used and what browser did you used.

Would you be willing to talk with future A Broader View volunteers upon your return to share your experiences or take part in other A Broader View activities and programs?     
   Preferred method of communication:

References
Please provide us with the names and contact information of two (2) personal references. One reference may be a friend. The other reference must be an employer, teacher or professor. No family members please. A Broader View reserves the right to contact these individuals during your application process.
Name:
Relationship to you:
Telephone #:
Email Address:
  
Name:
Relationship to you:
Telephone #:
Email Address:
 
 

Have you been convicted of a felony?
  


Within the past five (5) years have you been convicted of, or completed a period of incarceration for, a misdemeanor which was not a first conviction for drunkenness, simple assault, speeding, a minor traffic violation, an affray, or disturbing the peace?
  

Please Note:
1. Conviction of a crime or a guilty plea to a criminal charge will not necessarily disqualify an applicant. A Broader View will consider the gravity of the offense, the time passed since conviction or plea and the nature of the volunteer position sought.
2. An applicant with a sealed record on file with the commissioner of probation may answer ‘no record’ with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant may answer ‘no record’ with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services that did not result in a complaint transferred to the superior court for criminal prosecution.

The volunteers have read and understand the Terms & Policy.
Please make a selection.YES I Understand




You can mail or fax your application or payment to us:
A Broader View Volunteers. P.O. Box 14. Wyncote, PA 19095
Tel: 215-782-1845 Fax: 215 887-0915