Personal Information	
Family Name		
Given Name(s)		
Address		Number		
Postal Code		Town		
Country		
Phone		Fax		
Mobile		e-mail		
Date of Birth		Place of Birth		
Nationality		Sex	 female	 male	
What languages do you speak?	
Languages	Basics	Enough	Good	Mother Tongue	

					
					
What is your highest diploma?		
Do you work, study… (specify, please)?		
Did you follow courses next to school?
(if yes, please specify)		
Do you have a driver’s licence?	 yes	 no	
Do you smoke?	 yes	 no	
Are you a vegetarian?	 yes	 no	
Do you have allergies?	 yes	 no	
If yes, please specify:		
Any special medical or dietary needs?	 yes	 no	
If yes, please specify:		
Any other useful information?		

Can you give three good character traits?	1.	
	2.	
	3.	
Can you give three less good character traits?	1.	
	2.	
	3.	

Please give the four most interesting themes for you:	
 art and culture	 social exclusion (in general)	
 environment	 social integration	
 heritage protection	 measures against delinquency	
 rural development	 youth information	
 urban development	 youth policies	
 equal opportunities	 youth leisure	
 anti-racism / xenophobia	 youth sports	
 health	 media and communications	
 anti-drugs/substance abuse	 European awareness	
 other	

Please indicate with which target groups you would like to work (max. 2):	
 youth and children	 unemployed	
 elderly	 migrants	
 disabled people	 local community	
 homeless	 other (specify, please:)	

What is your motivation to do an EVS project?	

What would you like to do on an EVS project?	

What are your hobbies?	

Do you have previous international or intercultural experiences?	

Do you have experience in youth work? If yes, please specify.	

Do you have experience in being a volunteer? If yes, please specify.	

Sending organisation	

Name		
Address		Number		
Postal Code		Town		
Country		Phone		
Fax		website		
Contact Person in charge of EVS	
Name		Phone		
Fax		e-mail		

Remarks of the sending organisation on the volunteer :	

Signatures	
Place & Date		Place & Date		
Name		Name