VOLUNTEER TEACHER APPLICATION FORM
I. GENERAL INFORMATION
Name
First
Middle
Last
Current Address   Street
  
City
State
Zip
Country (if not USA)
Phones
Home
Work
Cell
Present Address Valid Until   
Permanent Address   Street
  
City
State
Zip
Country
Phones
Telephone
Fax
Email
Current
Permanent
Country of Citizenship   
Date of Birth   
Gender m f
Passport
Number
Expiration date
Place of Issue
Date of Issue
Date of Application
Names on Passport:
First
Last


II. EDUCATION
Undergraduate College/University
Name of School
Year of Graduation
Major
Minor
Grade Point Average
Graduate University
Name of School
Degree
Area of Concentration
Date Awarded
Other Education   
Other Specialized Training   


III. PROGRAM SELECTION
Please indicate which program you are applying to:
First Choice
Second Choice (Optional)
Please indicate which departure month and year you are applying for:


IV. EXPERIENCE
Please list your experiences in the following areas in reverse chronological order.
Teaching Experience
Please describe in detail any teaching experience you have had. Include formal classroom experience as well as informal experience, such as tutoring, coaching, or special training.
Professional Experience
List past employment including: employer, position, brief description of responsibilities, and dates of employment.
Volunteer and Community Service Experience
List past volunteer or community service work. Include organization (if any), brief description of the type of volunteer work you did, and the dates of your service.
Overseas Work/Living Experience
List any previous overseas experience. Include country or region, dates and length of stay. First list any work or living abroad experiences, and then any travel overseas. (Do not include travel in your native country, if different than the U.S.)
Overseas Travel Experience
Is English your native language? Yes No
Please note: for year-long programs WorldTeach has contracts with schools and governments that have requested native English speakers
Foreign Language Skills
Indicate the non-English languages you know, your years of study, and your approximate level of proficiency.
Language Years of Study:
High School		 Years of Study:
College		 Reading Fluency Writing Fluency Speaking Fluency
Spanish
French
German
Polish
Mandarin
Cantonese
Other
Other Language Specify:


V. REFERENCES
Your references should use the separate Reference Forms contained in Part II of the WorldTeach Application. So that we know who will be submitting these references, please provide the names and contact information for your references here.
REFERENCE I
Full Name
Address   Street
  
City
State
Zip
Country
Phone
Email
REFERENCE II
Full Name
Address   Street
  
City
State
Zip
Country
Phone
Email


VI. ADDITIONAL INFORMATION
WorldTeach does not discriminate on the basis of race, ethnicity, religion, gender, sexual orientation, disability, age, or marital status. However, because we place volunteers in challenging circumstances in developing countries and with local host families, we may not be able to accommodate persons in some of our programs who have physical disabilities, serious health limitations, or persons who require special housing arrangements.

Do you have any physical or emotional limitations, any allergies, or other impairments that would limit placement options or participation in everyday teaching or community activities?
Yes
If yes, please explain
Do you require any specialized housing arrangements?
Yes
If yes, please explain
Have you ever been convicted of a felony or a misdemeanor?
Yes
If yes, please explain
While the WorldTeach structure provides support for unforeseen or emergency volunteer needs, each volunteer must be responsible for his or her own physical, emotional, and mental health while abroad, including obtaining any medications. Are you able to assume full responsibility for your physical, emotional and mental health while a volunteer?
Yes No
If no, please explain
Ethnicity: (Voluntary: you do not have to fill this section out)
WorldTeach is committed to equality of opportunity for individuals of all backgrounds. Completing the information will assist us in furthering that commitment. This information will not factor into an admissions decision
African American
Asian American
European American
Latin American
Native American
Other

Other Ethnicity Specify:


VII. WHERE DID YOU HEAR ABOUT WORLDTEACH?
Where did you first hear about WorldTeach?
Please specify
Where and what were ALL of the places and ways you have heard or read about WorldTeach?
Internet search Internet link Returned WorldTeach Volunteer
Friend College Career Office Professor
Career Fair Poster Directory/Book
Magazine/Newspaper Radio/TV
Which of the contacts with WorldTeach was most influential in your decision to apply?
****Thank you for completing Part I of your application. Please see www.worldteach.org/apply for details on how to submit Part II.****