Application Form

PEACE HUMANITY INTERNATIONAL

      Box WJ 257, Weija-Accra    Tel…024402294, 0267212264.    Email:…phumanityint@gmail.com

PLACEMENT FORM

Name of volunteer:………...………………………………………………………………...…….

Date of birth: ……………………………

Sex ………………………………………………………………………………………………….

Nationality: ………………………………………………………………………………………...

Postal address: ………………………………………………………………………………….....

Physical address: ……………………………………………………………………………….....

E-mail: ……………………………………………………………………………………………...

Telephone: ………………………………………………………………………………………….

Highest Educational Qualification: ………………………………………………………………..

Present employment: ……………………………………………………………………………..

Position at work place: ……………………………………………………………………………

Indicate voluntary work experience that you have had and the duration ………………………….

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Emergency contact person……………………………………………………

Phone number………………………….Email………………………………..

Preferred duration for placement (tick):

Short-term:                  2- 4 weeks        

Medium-term:             4 weeks -12 months    

Long-term:                  1-2 years

Proposed dates for Placement: From………………………To…………………………….

Please indicate your area/s of interest by ticking

1. Teaching (tick the level)

a. Nursery / Kindergarten

b. Basic: Primary

c. Basic: Junior High School

d. Senior High School:

Underline the subject/s that you wish to teach.

Chemistry, Biology, Physics, I.C.T., Agriculture, Geography, English, French, Social Studies, Catering, Graphic Designing, Picture Making, Sculpture, Textiles, Woodwork, Building and Construction, Electronics, Plumbing, Electricity.

       Others (specify)…………………………………………..

2. Construction (Building of School, Health Facility, Library etc.)

3. Environmental Protection (Forestation, Cleaning, etc.) 

4. Healthcare (Hospital, Clinic, Mental Home, etc.)

5. Orphanage/Children’s Home

6. Rehab Centre

7. Public Health (HIV/AIDS, Drug Abuse, Malaria (etc.)

Other Interests (specify)…………………………………………………………..

Additional Information: e.g. (Allergies, restrictions etc.)

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