Fiche d'inscription SVE

EVS Volunteer Exchange Form

Name/Nom:
Sexe:

Male

Firstname/Prnom:
Female

Birthdate/Date de naissance:

Age:
Nationality/Nationalit:

Birthplace/Lieu de naissance:

Personal Address/Adresse Actuelle:

Personne prvenir en cas

d'urgence/Emergency contact:

Tel:
____________________
Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Tel:
____________________
Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Passport N:
Numro de scurit sociale/ Social Security Number:

I apply for the following projects: country, field/ Je vous adresse une demande pour les
projets suivants: pays, theme :
1.........................................................................................................................
2.........................................................................................................................
3.........................................................................................................................
What period would you like to volunteer (please give earliest and latest dates)? / Quand
voudrais-tu participer un projet de volontariat, pour combien de temps?

Do you have any health problems (e.g. allergies)? / As-tu des problmes de sant (ex:
allergies)?
Special needs / besoins spciaux (ex: vgtarien, besoins physiques):
Present occupation/ Activit actuelle:
Profession/ activit professionelle: ___________________________________
Student/ tudiant
unemployed/ en recherche d'emploi
Others/Autres : __________________________________________________

What is your study level?/Quel est votre niveau d'tude?

Do you have driver's licence?/ As-tu le permis de conduire?

Yes / Oui
No / Non
Language skills / comptences linguistiques:
Speak well/ parle bien:_______________________
Speak some/ parle un peu:_________________________________
Have you ever done any volunteer work? What kind?/ Quelle est ton exprience de volontariat?
none/aucune workcamps/chantiers group activities/activits de groupe
animation/project leading
other/autres: ______________
Why do you wish to take part in a long term voluntary project?/ Pourquoi veux-tu participer
un projet de volontariat?
_________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Where do you see your strengths for doing this service?/ Quelles sont tes forces pour
participer ce service?
__________________________________________________________________________
__________________________________________________________________________
What are your expectations?/ Quelles sont tes attentes?
__________________________________________________________________________
__________________________________________________________________________
What are your fears?/ Quelles sont tes craintes?
__________________________________________________________________________
__________________________________________________________________________
Other comments/ autres commentaires:

PLEASE SEND THIS FORM BACK WITH A MOTIVATION LETTER FOR EACH PROJECT YOU ARE
APPLYING FOR TO SERGIO ltv@solidaritesjeunesses.org