Community service application form

Please complete this application form to have your proposed community service approved for the International Development minor, option, or research specialization stream.

Information and privacy: questions regarding the collection of information on this form can be directed to the form administrator.

First Name * (required)

Last Name * (required)

UW Student ID * (required)

Program * (required)

UW Email * (required)

Current term you are enrolled in * (required)

Current Address

Postal Code/ZIP(+4) code * (required)

Country * (required)

Address * (required)

Address line 2

City * (required)

Province/State

Day time phone number * (required)

Contact person first and last name * (required)

Relationship to student * (required)

Emergency Contact's Phone Number * (required)

Emergency Contact's Email Address * (required)

Please ensure you notify this person that you have indicated that he or she is your emergency contact.

Name of Host Organization * (required)

Host Organization Country * (required)

Canada

If International, please state Country

Host Organization Country If International, please state Country

Host Organization Address

Postal Code/ZIP(+4) code * (required)

Country * (required)

Address * (required)

Address line 2

City * (required)

Province/State

Host Organization Website * (required)

Contact Person & Title * (required)

Phone (inc. country code) * (required)

Contact person's email * (required)

Contact person's Skype (if applicable)

Student Assignment/Job Title * (required)

Start & End Dates (Estimated) * (required)

Total Expected No. Weeks/Hours * (required)

Job description (if available) * (required)

What is your expected role and/or key duties? * (required)

In your own words, describe the purpose and type of service this organization or initiative offers * (required)

How is this experience relevant to the INDEV mission and what you’ve learned in your INDEV courses? * (required)

What type of knowledge and/or skills do you hope to gain from this experience? * (required)

How did you find this opportunity? (i.e., through a family member or friend, INDEV suggested sites, internet search, coop/jobmine, professor, prior work experience) * (required)

International only - What is the estimated total cost of this experience – including airfare, accommodation, food and living allowance, and other fees if applicable.