APPLICATION

 


Please complete the following application form in its entirety.  Resume copy, three reference forms, heath forms, scholarship application, and the $100 application fee should be mailed in separately. (Checks made payable to International YMCA Go Global)
 

  

International YMCA Go Global Program
5 West 63 Street
Second Floor
New York, NY 10023
 

  Last Name:   First Name: Middle Name:

  Address:   City:   State:   Zip:

  Phone: E-Mail:   Gender: Married?

  Birthday: Day: Year:   Social Security #:   Citizen of:  

  Smoke:   Are you a student?   Field of Study/Occupation:

  Passport Number:

  Top three countries to volunteer in:
       

  Dates available for placement (at least two months)
  Beginning date: Departure from host country:

  Check areas/organizations with which you have experience:
  YMCA  Boy/Girl Scouts  Learning Disabled  Physically Handicapped    Other:

  Emergency Contact:
  Name:   Phone:   Relationship:   E-Mail:

 Check all of your skills related in each of the areas below.  Rate your skill level and teaching ability according to the number scale.
 Please don't limit yourself to the categories listed.  If a talent that you have is not there, just add it in!
 1 = Excellent  2 = Very good  3 = Good  4 = Fair                                      K stands for knowledge of   T stands for Teaching Ability

 Waterfront

K

T

   Arts

K

 T

  Development Skills

K

T

    Sports

K

T
 Life guarding  Music  Fundraising  Archery
 Swimming  Painting  Social Work  Riflery
 Kayaking  Photography  Empowerment & Leadership training  Tennis
 Canoeing  Acting  Environmental Education  Fencing
 Windsurfing  Nature  craft  Computer Programming  Volleyball
 Sailing    Health Education  Basketball
     Rollerblading
               Skateboarding
 
 Educational Skills K T  Languages

K

T

  Certificates  Previous Volunteer
 Experience
 Tutoring  Spanish  First Aid Agriculture
 Teaching English  French  CPR Business
 Camp Counseling  Chinese  Life Guard, name of  Certificate Community Dev
 Guidance work  Japanese Education/Train
 Therapeutic Service  German  International Drivers License number
Expires 		Environment
 Child Care   Health
 Working with the disabled       Construction
       

 A. Describe your best skills and experience in each skill areas on above.

 B. Education/Work Experience

   Schools Attended  Vocation/Field of Study  Degree Earned  Dates Attended

1.

2.
         
   Position Held  Duties/Responsibilities    Dates of Employment

1.

2.
       
  Resume Required    

 C. Purpose of the Experience
     List at least three reasons you are applying for this international experience.

1.

2.

3.

 D. Briefly describe yourself and background.
     

 E. Describe your qualifications for working with an overseas YMCA or community service organization:
     

 F. What do you hope to gain from this international experience?
     

 G. Why should an overseas community service organization have you volunteer in their programs?
     

 H. What do you have to offer your host and the community you will be working with?
     

 Other Information

 Do you have any illness or condition that may effect your full participation in the program? Yes  No
 If yes, please explain:
     

 Have you ever had emotional or mental illness? Yes  No
 If yes, please explain:
     

 Do you have any allergic or dietary needs or restrictions?  Yes  No
 If yes, please explain:
     

 Have you ever been convicted of a crime?  Yes  No
 If yes, please explain:
     

We need a photograph of you, please send an email to ips@ymcanyc.org.  We will hold your application until we receive your photo.  Thanks.

    

PLEASE only Submit once!
You will receive a confirmation, so please wait.