VOLUNTEER PROFILE FORM
I. GENERAL INFORMATION

Please fill out this form only after you have received an acceptance packet from WorldTeach. This form is one of a few items we need in order to confirm your participation in the program. Information on the other required items (including the Conditions of Participation and deposit) can be found in your WorldTeach acceptance packet. Please complete all of the fields in this form so we can make well-informed decisions about your site placement. Thank you!
Name
First
Middle
Last
Place of Birth  
Marital Status
Single
Married
If you are married or have dependents, will your spouse or dependents be going abroad with you?
Yes
No
If yes, please explain:   
Age   


II. FAMILY AND EMERGENCY CONTACT INFORMATION
MOTHER
Title
First
Middle
Last
Maiden name   
Home Address   Street
  

City
State
Zip
Country
Work Address   
Phones
Home
Work
Cell
Email   
Occupation   
FATHER
Title
First
Middle
Last
Home Address   Street
  

City
State
Zip
Country
Work Address   
Phones
Home
Work
Cell
Email   
Occupation   
SPOUSE/NEXT OF KIN
(if not parents)
Title
First
Middle
Last
Maiden Name   
Relationship To You   
Home Address   
Work Address   
Phones
Home
Work
Cell
Email   
Occupation   
INFORMATIONAL CONTACT: Occasionally the field director or US Office will send general program updates to your family or other persons you designate by email. Whom should they write to?

Name
Email
Name
Email
Please designate 2 people whom WorldTeach can contact in an emergency: You will need to inform WorldTeach and the field director if this information changes while you are abroad.
EMERGENCY CONTACT
PERSON #1
Title
First
Middle
Last
Maiden Name   
Relationship To You   
Home Address   
Work Address   
Phones
Home
Work
Cell
Email   
Occupation   
EMERGENCY CONTACT
PERSON #2
Title
First
Middle
Last
Maiden Name   
Relationship To You   
Home Address   
Work Address   
Phones
Home
Work
Cell
Email   
Occupation   
PRIMARY CARE PHYSICIAN
Name   
Address   
Phone   
Fax   
Email   
INSURANCE BENEFICIARY: the following information will make it easier for us to apply for your insurance coverage:

First
Middle
Last
Relationship To You   
Address   
Telephones   
Fax   
Email   


III. GENERAL PLACEMENT INFORMATION
The information in this section is important. It is intended to tell us more about you and to help us match you with a school and host community. Note that not all of these options are available at all programs. Check our website and program literature for more information on the placements available in your country. There are no “right” or “wrong” answers to these questions--you have already been accepted by WorldTeach and the only contingency for your full acceptance is your health report. We want to learn more about you as an individual. Please remember that, although we will keep in mind any specific placement requests you have, WorldTeach cannot promise to meet all your preferences or arrange any specific placement for an individual volunteer.
LOCATION
Would you prefer living in the capital city?
Would you prefer to live in an urban setting?
Would you prefer living in a small town or village?
Would you prefer living in a remote or rural area?

Please explain your interest in a particular part of the country or sort of placement.

Is there a specific location or type of placement you feel you cannot live and work in?

SELF-DESCRIPTION
What are your hobbies and interests?

How would you describe yourself? (Are you introverted or extroverted? Do you like to go out a lot or do you enjoy staying home?)


IV. SPECIAL CONSIDERATIONS
FOOD AND ALLERGIES
Do you have dietary restrictions? Yes No
If yes, please explain.
If you are a vegetarian, please explain exactly what you can and are willing to eat and what you are not willing to eat.
Do you have any allergies or other constraints that might affect your placement? Yes No
If yes, please explain.

ALCOHOL AND TOBACCO AND OTHER
Do you drink alcohol?
Is it OK with you to live with someone who drinks?
Do you smoke cigarettes, cigars, or a pipe?
Is it OK with you to live with someone who smokes?
Do you have any strong dislikes or phobias that might affect where we place you? Yes No
If yes, please explain.

RELIGION (Optional)
What is your religion (if any)?
Do you practice it?
If yes, do you have any special religious needs?


V. LANGUAGE SKILL AND COMFORT LEVEL
We would like to know how comfortable you are in the national language of the country you will be volunteering in, as well as to know to type of cultural immersion you prefer.
What is the local language of your program country?
How would you describe your current language ability in speaking the local language?
How would you describe your current language ability in reading the local language?
How would you describe your current language ability in writing the local language?
Would you prefer to be immersed in the local language?
Would you prefer that your host family members be able to speak English?
Would you prefer to be placed near another volunteer or native English speaker? >


VI. TEACHING AND TRAINING CAPABILITIES
Are you a certified teacher? Yes No If yes, where certified?
Have you taught elementary school? Yes No If yes, for how many years?
Have you taught middle or junior high school? Yes No If yes, for how many years?
Have you taught high school? Yes No If yes, for how many years?
Have you taught college or adults? Yes No If yes, for how many years?
Are you able to train other local teachers? No Only informally In some areas Yes
Please explain what teacher training you would be comfortable doing.
Often WorldTeach volunteers are asked to teach subjected other than English. The following questions are about your general comfort level in teaching at the various levels, not your certification to do so. If you were good at math in high school, for example, you would probably be a good high school math teacher, even if you were not a math major in college. Please let us know what you could teach, if it were needed at your school.

Other school subjects you could teach at the elementary level: Check as many as apply.
Math Science History
Geography Computers Life Skills
Music Art Sewing/Cooking
Industrial Arts/Shop Physical Education Health
Other:

In addition to teaching English, which other school subjects could you teach at the high school level?
Math Science History
Geography Computers Life Skills
Music Art Sewing/Cooking
Industrial Arts/Shop Physical Education Health
Other:

In addition to teaching English, which other school subjects could you teach at the adult/community college/college level? Check as many as apply.
Math Science History
Geography Computers Life Skills
Music Art Sewing/Cooking
Industrial Arts/Shop Physical Education Health
Other:

Do you have any vocational or manual skills you could teach or share?
Carpentry Auto Mechanics/Repair Construction
Agriculture Car Repair Metal Working
Pottery Sewing First Aid
Other:

In addition to teaching English, what other extracurricular activities or community projects interest you?
Sports/Intramurals Yearbooks/Newspapers Computers/Internet
Drama Music Debate
Service clubs Student government Language clubs
HIV/AIDS Clubs Arts/Crafts Environmental Education
Local culture/history Radio/TV Scouting
Construction/painting Adult Education
Other:


VII. TEACHING PREFERENCES
(NOTE: Some of these may not apply to your country program. If they do not, please choose N/A. )
Would you prefer teaching at an elementary school?
Would you prefer teaching at a middle school?
Would you prefer teaching at a secondary school?
Would you prefer teaching adults?
Do you feel capable of teaching large classes (over 30 students)?

In what type of school and at what level of teaching do you think your skills and experience could be best used? Why?
Note that some programs have classes that are quite large. Be sure to check this out for the program you are applying for if this isn’t something you are comfortable with.


VIII. HOST FAMILY PREFERENCES
(Skip only if your program does not make any host family placements. Some countries have only host family placements, some have only school placements and some have both. )
Would you prefer to live with a host family?
Would you prefer living in school housing or an apartment?
Would you prefer to live with a family without small children?
Would you prefer to live with a large family?
Would you prefer to live with a small family?
Could you live with a family headed by a single woman ?
Would you prefer to live with a family that has pets?
Do you need a house with a telephone?
NOTE: In some countries everyone will have a phone, in others not.
Would you prefer to live with a family that shares your religion?
What else should we know about you in making a living placement for you:


IX. OTHER
Is there anything else you want WorldTeach to know about you in order to make appropriate placements for you?