Volunteer Application Form
RequiredRequired Question(s)
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:
Country:

2.

How did you hear about Village Health Works?

 

50 characters left.
Required 3.
What languages do you speak?
In the comment section, please indicate level of fluency (Basic, Intermediate, Fluent)
English
French
Kirundi
Other  
  • Comment:

  • 500 characters left.
Required 4.
Where are you interested in volunteering?
New York
Kigutu
Remotely (or IT support / Fundraising / Committee / Grants writing ...)
Required 5.

 

350 characters left.
Required 6.



 

1000 characters left.
Required 7.



Health Care Program
Education Program
Food Security Program
Economic Development Program
Other  
  • Comment:

  • 500 characters left.
8.



 

50 characters left.
Required 9.

Please describe any previous volunteer or relevant work experience.

 

350 characters left.
10.

Volunteers are based in Burundi. How many weeks/months can you commit to volunteering? Please indicate when you would be willing to volunteer (indicates weeks or months that would work for you)

 

350 characters left.
11.
Accommodation in Kigutu is limited, with shared dormitory rooms being the norm for both staff and visitors. Please note here if mobility via stairs to our dorm's second floor or an upper bunk would be an impediment.
Shared room (twin beds)
Dormitory (bunk beds)
Tent (single)
12.
Would you require any special assistance from VHW to achieve your goals? translation support, vehicle needed for community-based work, particular equipment etc.
Translation support
Vehicle needed for community-based work
Particular equipments
Other  
  • Comment:

  • 500 characters left.
13.

Are you able to cover the costs of your time at VHW?

Yes
No
Required 14.
Reference #1: Please include your reference's first and last name, email address, work and home phone numbers, and describe this person's personal or professional relationship to you.
 

1000 characters left.
Required 15.

Reference #2: Please include your reference's first and last name, email address, work and home phone numbers, and describe this person's personal or professional relationship to you.

 

1000 characters left.