KIDS STUDYING EURASIAN NOMADS
Volunteer Application Form
(May also be requested by mail from the address below)
Summer 2000 Expedition to Altai Mountains, Mongolia
Volunteers, please check the session(s) you would like to attend:
___Session One: July 12-29; Tax Deductible Donation to KSEN-$2,000
___Session Two: August 1-17; Tax Deductible Donation to KSEN-$2,000
Donation does not include airfare or other travelling expenses. Dates may be subject to change.
Application, background verification, and $300 deposit are due before April 1, 2000.
The deposit is non-refundable after you have been accepted into the program.
Balance of Donation, ($1,700, due on or before May 1, 2000 __________________________________________________________
Before trip, volunteer required to:
1. Obtain emergency medical insurance ($100)
2. Obtain proper immunizations
3. Background Check (Request form from KSEN at the address listed below. Allow two months for processing background check.)
Mailing Address if different from above______________________________________________
Home phone (____) _____________ email address ______________________________________
Sex____ Height_____ Weight_____ Social Security
Passport Number_________________________________________ expires_________________ (if you do not yet have a passport, you can leave this part blank for now. Please apply for a passport as soon as possible at your local post office. You must have a passport to go on this trip).
If you are a student, please elaborate.
Phone (____) ________________________________________________________________
Relationship___________________ Home Address_____________________________________
Home Phone(__) ____________________; Cell Phone(___) _______________________________
Work Phone(__) ____________________; Other Phone(__) ______________________________
Medical treatment will not be equal to the norm in the US. Please be sure to list all special medical conditions you may have.
Blood Type______Special Diet_______________________________________________________
Diabetes____ Epilepsy____ Asthma____ Allergies_________________________________________
Other Medical Conditions_____________________________________________________________
Loss of Consciousness (explain and give date)_______________________________________________
Corrective Lenses/ Contacts__________ Date of last physical examination_______________________
Along with this application, please provide the following:
1. Three reference letters, preferably from people who have known you more than one year. Please provide their names, addresses., phone numbers, and e-mail addresses here:
2. A one-page, single spaced, personal essay. Please supply the following information in the essay: a) tell about yourself (education, experiences, interests, future goals) b) give 3 reasons why you would like to participate in this expedition c) give 3 reasons why you think you would make a good KSEN team member
3. A photo of yourself to be put on KSENŐs website.
As a team member of the KSEN project, you must adhere to regulations and maintain a standard of good conduct. KSEN reserves the right to require a volunteer to withdraw at any time if conduct and behavior jeopardizes the welfare of the children or fulfillment of the objectives of the project. It is understood that the volunteer will assume all responsibility, either financially or otherwise, for any illness or injury which might occur during the expedition. Emergency transport, medical or hospitalization costs resulting from illness or accident during the expedition are the responsibility of the volunteer receiving such care. In cases where the project leader, in consultation with the volunteer and local medical authorities, considers it necessary, a volunteer will be sent home or hospitalized. KSEN will make every effort to ensure that ill or injured volunteers receive proper medical attention. The volunteer is aware that while taking part in this project, certain exposure to risk may occur. Exposure may include but not be limited to: accident and/or sickness without readily available medical facilities, the forces of nature, travel on the ground and in the air, and others. In consideration of the right for the volunteer to participate in this project, he or she assumes all of the risks involved and agrees to indemnify and hold the sponsors of the project harmless for any and all liability that may arise in connection with participation in the activities. I have read and fully understand and accept the conditions for participating as detailed above.
Print Name__________________________________________________________________ Date_______________________________________________________________________
Please send application packet, background verification, and deposit of $300 made payable to KSEN to:
KSEN, Suzanne Lettrick, Center for the Study of Eurasian Nomads, 1607 Walnut Street, Berkeley, CA 94709
Phone: (510) 549-3708 FAX: (510) 849-3138 E-mail:firstname.lastname@example.org