Application Form – Yearoutindia

Before filling out this application, please read the Yearoutindia FAQ and the Volunteer Information Booklet. All fields in red must be completed.

Preferred Program

Preferred Start Date

Preferred Duration

Second Choice Program

Second Preferred Start Date

Second Preferred Duration

If you would like to take part in more than one program, please choose The Yearoutindia “Do It All” Program from the program list or tick this box

VOLUNTEER INFORMATION

Title

First Name

Surname

Preferred First Name

E-Mail Address

Email you use while travelling (if different from above)

Mailing Address

City

Postcode

Country

Phone (home)

Phone (mobile)

Occupation

Date of Birth

Gender

Male

Female

Nationality

Do you have a Valid Passport?

Yes

Passport Number (Optional)

Place and date of issue (Optional)

Expiry date

Please Tick this box if you want to receive email newsletters from Yearoutindia. Please note we DO NOT pass your information to ANY third parties

EMERGENCY CONTACT DETAILS

Name

Relationship to you

Phone (home)

Phone (mobile)

Address

HEALTH AND PHYSICAL FITNESS

Do you suffer from any of the following?

Asthma

Yes

Epilepsy

Yes

Diabetes

Yes

Allergies

Yes

Do you take any prescription drugs or medication?

Yes

Have you had any psychological / psychiatric illness in the last three years?

Yes

If yes to any of the above, please supply more info.

Do you have any special dietary requirements?

Yes

If Yes, please specify :

Do You Smoke?

Yes

Can you swim 200m unaided?

Yes

VOLUNTEER INTERESTS

Please introduce yourself to the Yearoutindia Coordinator/Program staff by telling us a bit about your interests, previous travel / volunteering experience, language skills, first aid, and any other relevant information or qualifications which might be useful.

Please give your reasons for applying to join this internship / program / project. What do you hope to gain from it?

Please tell us if you have any queries about the program which you are joining?

Where did you hear about Yearoutindia?

VOLUNTEER / PROJECT APPLICATION FORM

VOLUNTEER INFORMATION

EMERGENCY CONTACT DETAILS

HEALTH AND PHYSICAL FITNESS

VOLUNTEER INTERESTS