Application - Step 1

Contact Details
Personal Details
Program
Skills and References

Required Fields: *

Contact Details

First Name: *

Last Name: *

Company:

Phone: *

Mobile Phone:

Fax:

E-mail: *

Address: *

(line 2)

City: *

State:

Zip Code:

Country: *

How did you find out about us?

Personal Details

Select your Gender: Male Female

Date of Birth(mm/dd/yy):

Country of Citizenship:

Languages Spoken:

Special Dietary Requirements:

(While Cultural Canvas Thailand will attempt to accommodate most dietary needs, we make no affirmation that we will meet the requirements of all diets. Upon receipt of your application, a staff member will contact you regarding your specific dietary requirements.)

Program

Although we will do our best to place you in your preferred program, sometimes this is not always possible. Therefore, it is important that we know your second and third choices so that we can place you accordingly. If you have no interest in working in a certain program, leave it marked as 0.

Please number the programs below in order of importance to you, 1 being the most important 5 being the least.

Burmese/Migrant Assistance Program

Hill Tribe Assistance Program

Assisting children affected by HIV/AIDS

Single Mothers Program

MSM and HIV/AIDS Outreach and Education Program

Art Relief Program

Environmental Protection Program

Teaching English in Rural Schools

Street Dog Rescue Program

Assisting Children with Disabilities Program

-- OR --

Are you a Skilled Professional?

If yes, Please specify your specialized skill in the box below.

Would you like us to choose an organization that can best use my skills.
Yes No

-- OR --

Intern?

Are you interested in an intern position? Yes No

Intern Program:

Project Start Date (2012):

Project Duration:
(Make sure you have checked the minimum durations for your desired project)

Please write any additional information that you would like us to know about your volunteer or internship position:

Skills and References

Is this your first time volunteering? Yes No

The following apply only to volunteers who HAVE experience:

Please give details on your volunteer experience:

Please list any skills and past work experience:

Please explain why you are interested in volunteering with Cultural Canvas Thailand:

References

1.)

Name
Relationship
Phone
Email Address

2.)

Name
Relationship
Phone
Email Address

3.)

Name
Relationship
Phone
Email Address

NOTE: If you are working on a sensitive issue, background checks and further information may be required.

SECURITY QUESTIONS

2+2= ?