(Please cut and paste the questions and your responses into an email to both of the following address: upavim@itelgua.com). If you do not receive a timely response, please email goyonorman@yahoo.com.

NAME:

ADDRESS:

HOME PHONE:

WORK PHONE:

E-MAIL ADDRESS:

FAX:

DATE OF BIRTH:

GENDER:

Please list any health concerns (medication, allergies, physical limitations, etc.):

Are you covered by accident or health insurance?

Who is your insurance provider?

Is coverage provided outside of your home country?

For how long?

In case of emergency, please contact

Name:

Relationship:

Address:

Home Phone:

Work Phone:

email address  and/or fax:

Your Spanish language skills

Ability to speak:

Ability to read:

Ability to write:

Where did you first hear about UPAVIM?

What would be the length of your volunteer commitment with UPAVIM?  (Please give dates)

Please elaborate on the following questions.  A resume is also optional.

International travel experience:

Have you lived in another culture before?  When and where?

Occupation or course of study?

List previous job experiences (include volunteer work):

Have you lived in a communal living situation before?  Where and when?

What are some of your talents, hobbies, or other interests?

What causes you stress?   How do you respond to such situations?

What is important to you in a work setting?

What are your personal goals for your epxerience with UPAVIM?

What are your expectations or concerns about living in an impoverished community without some of the conveniences you may be accustomed to?

Do you understand that La Esperanza as a community (and Guatemala as a country) suffers from chronic social problems, including gang violence and social unrest? As every eperience involves some difficult aspects, what potential difficulties do you foresee?

What are your long-term goals, and how does UPAVIM fit into these goals?

Thank you for considering working with us.  We hope to hear from you soon.

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