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MASK
VOLUNTEERING APPLICATION FORM
Name _______________________________________________________
Gender male __________ female _____________
Contact address _______________________________________________________
__________________________________________________________________________
Contact telephone ___________________________
Email ___________________________
Age ___________________________
Date of birth ___________________________
What do you do/specialise in? ________________________________________________
Your personal qualities and any skills and experiences
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
What is the highest educational qualification you currently have?
__________________________________________________________________________
Are you currently a resident in UK? ________________
Passport details: number, issue date, expire date, issued by
__________________________________________________________________________
Emergency contact person/s, name, address, tel numbers
__________________________________________________________________________
Ethnic origin __________________________
Active religion (if any)? If you don't have one, please put 'none' ________________________
Have you ever been working in Africa before If Yes, please give brief details
__________________________________________________________________________
Which MASK’s programme are you interested in participating?
Working in Sipili schools _____________
Working in Naivasha schools _____________
Building Inchurra _____________
Health and Personal Information
Have you ever had any serious illness? __________________________________________
Do you have any physical limitations? ___________________________________________
Have you ever had any mental or nervous problems? _______________________________
Are you undergoing any kind of medical treatment (including taking pills or drugs)? __________________________________________________________________________
Do you have any allergies? ___________________________________________________
Do you have any dietary restrictions such as vegetarian, halal, etc? __________________
Do you have any medical condition(s), however minor? _____________________________
If you have answered 'Yes' to any of the above please give details
Criminal Record
Do you agree to complete a Standard Disclosure Criminal Records Bureau (CRB) check form, cost £30? ____________________
Have you ever been arrested, convicted or cautioned for any offence (spent or unspent) including driving offences? If yes, please give details, including the dates, offence and penalty. (This information will not necessarily disqualify you. Each application is considered
on its merits) ____________________
Application Declaration
Have you read Terms and Condition? ______________
I understand that if I am accepted onto this programme I will be living in difficult conditions in a developing country. I agree to obey the local law and be respectful of other people’s culture, traditions, customs, religious beliefs and practices. I understand all the details of MASK as given on the website and/or the all documents, and the Terms and Conditions of the programme. I agree to be bound by them and certify that all the statements I have made on this form are true.
Signed: ___________________________________________________________________
Date: _____________________________________________________________________
Please post it to:
Director,Mobile Art School in Kenya (MASK), One, St Paul’s Churchyard, London EC4M 8S
together with £25 administration costs (cheques payable to Mobile Art School in Kenya)
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