1. Your general data
Leader's first name
Leader's family name
Leader's date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Leader's gender
male
female
Leader's nationality:
Group name:
Group type
Friends
Family
High School Students
Religious Group
University Students
Work Group
Youth Group
Other
Member 1
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 2
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 3
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 4
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 5
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 6
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 7
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 8
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 9
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 10
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 11
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 12
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 13
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 14
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Member 15
First name, family name
Date of birth (Day-Month-Year)
January
February
March
April
May
June
July
August
September
October
November
December
Gender
male
female
Please state any health condition of any of the group members, including allergies
(It is important for us to be aware of any condition so we can be prepared
in placing you)
2. Leader's contact details
Street address
State/Province/County
Town and Post/Zip Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia & Herzegovina
Botswana
Brazil
British Indian Ocean Ter
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Islands
Cape Verde
Cayman Islands
Central African Republic
Chad
Channel Islands
Chile
China
Christmas Island
Cocos Island
Columbia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Ter
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Hawaii
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malaysia
Malawi
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Nambia
Nauru
Nepal
Netherland Antilles
Netherlands
Nevis
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau Island
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
St Barthelemy
St Eustatius
St Helena
St Kitts-Nevis
St Lucia
St Maarten
St Pierre & Miquelon
St Vincent & Grenadines
Saipan
Samoa
Samoa American
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Serbia & Montenegro
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Tahiti
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Is
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (Brit)
Virgin Islands (USA)
Wake Island
Wallis & Futana Is
Yemen
Zaire
Zambia
Zimbabwe
Phone (home)
Phone (work)
Fax
E-mail address (please check!)
Alternate e-mail address
3. Leader's education and experience>
Highest qualification
High School Graduate
Undergraduate
First Degree Graduate
Second Degree Graduate / Master's Degree
Other
Other relevant qualification and skills (please describe)
Work and travel experience (please describe)
4. Group's education and experience>
Please describe the education and experience of
the members of your group as a whole and how it relates
to the work you wish to do while volunteering.
This will help us to identify a suitable project for you.
Other relevant qualification and skills (please describe)
Work and travel experience (please describe)
5. Volunteering>
How long would you like to volunteer? (Some periods may not be available
for certain programs)
Two weeks
Three weeks
One month
Six weeks
Two months
Ten weeks
Three months
Four months
Five months
Six months
When would you like to go to Kenya?
1st
15th
January
February
March
April
May
June
July
August
September
October
November
December
2006
2007
Which program would you prefer?
Teaching Program
Children Orphanage Program
Medical/Health Program
HIV/AIDS Program
Maasai Land Medical Program
Maasai Land Teaching Program
What is your interest in the Kenya Program (please describe)?
Do you require any further information? Please state.
Other volunteering projects along the Lake Victoria Region (please select
all areas that apply)
Teaching in Primary School
Teaching in Secondary School
Teaching/Assisting in Centre for Street Children
Volunteer and raise funds towards a project
HIV/AIDS education and awareness
Self help projects
Dressmaking
Shoe repair
Agriculture
Income genearting projects
Running a business
Vocational skills
Social work
Drug rehabilitation
Administration work (help run CadifKenya)
6. Other>
How did you locate our website?
Search engine
United travel
Another website
Someone
Event
Specifically:
I have read and agree to your Legal Terms of Service .
Yes, I would like to subscribe to your newsletter (optional).