Voluntourism Services Applications Step 1 of 3 33% Dates (when you would like to start and end volunteering if your application gets approved): I would like to start on:(Required) MM slash DD slash YYYY I would like to finish on:(Required) MM slash DD slash YYYY I would like to arrive at the center on:(Required) MM slash DD slash YYYY Approximately at (time):(Required) Hours : Minutes AM PM AM/PM Services to be provided (what you would like to volunteer in if you application gets approved):(Required)This application does not discriminate in securing volunteers on the basis of race, color, religious creed, national origin, sex, ancestry, age, or on the basis of handicap or disability and any other characteristic required by law. No question on this form is intended to secure information to be used for such discrimination. Full name:(Required) ID/Passport No:(Required) Nationality:(Required) Residence:(Required) Email:(Required) Date of Birth:(Required) MM slash DD slash YYYY Are you 18 years or older?(Required) Yes No Please specify your parents’ or guardians’ consent:(Required) Occupation:(Required) Social Security Number: What do you hope to gain from volunteering?(Required)Describe your formal/informal training and experience pertinent to the volunteer services you would provide.(Required)When are you willing to volunteer?(Required) MM slash DD slash YYYY Time(Required) Hours : Minutes AM PM AM/PM Would you like Akagera Good Neighbors to help you in terms of accommodation?(Required) Yes No Any comment about accommodation?(Required) How much would you afford to contribute during the volunteer tourism period?(Required) Have you ever been convicted of any criminal offense other than the following: Minor traffic violation fine $500.00 or less, or offenses settled in juvenile court or under welfare youth offender law.(Required) Yes No Please explain(Required)Names, phone number, and email of person to be notified in case of accident or emergency.(Required) Akagera Good Neighbors’ Position on the Worldwide Problem of Child Abuse When practical, volunteers should not put themselves in a position in which they are alone with a single child and cannot be observed by others. Allegations or suspicions of child abuse are taken seriously and are reported to police and/or public agencies for investigation. Akagera Good Neighbors’ goals for children are: To help children develop to their fullest potential. To deliver programs in a positive environment of safety, support and care. To support and strengthen the family unit. Additional Volunteer Code of Ethics and Rules I have been informed of Akagera Good Neighbors’ position regarding child abuse, and have read and understand that portion of my Volunteer Application and Agreement titled “Akagera Good Neighbors’ Position on the Worldwide Problem of Child Abuse.” I understand that in addition to the state mandates, Akagera Good Neighbors will, among other things, conduct a thorough check of my background. I understand that allegations or suspicions of child abuse are taken very seriously by Akagera Good Neighbors and will be reported to police and/or public agencies for investigation and that Akagera Good Neighbors will fully cooperate with any related investigations and will pursue the prosecution of child abusers to its full extent screening, I still desire consideration as a volunteer for Akagera Good Neighbors. Affirmation I hereby affirm that my answers to the questions on the application are true and correct, and that I have not knowingly withheld any fact or circumstances that would, if disclosed, affect my application unfavorably. I understand that any false information submitted in this application is cause for denial of this application or termination of my volunteer services regardless of when or how discovered; and that my service is subject to government regulations, Akagera Good Neighbors’ review and acceptance of fingerprint record. I hereby waive any right to claim that any request or investigation is an invasion of my privacy, since they are made with my consent and it is in my best interest while being considered for a volunteer position. I hereby acknowledge that I have read and understand the above statements and that I voluntarily sign this affirmation. Commitment Statement(Required) I agree Signature of Applicant(Required) Signature of Applicant’s Parent/Guardian (if minor)(Required) Date MM slash DD slash YYYY
