KIDS STUDYING EURASIAN NOMADS

Volunteer Teacher Application Form

(May also be requested by mail from the address below)

____________________________________________________

Summer 2000 Expedition to Altai Mountains, Mongolia

Volunteer teachers must commit to both sessions

Session One: July 12-29

Session Two: August 1-17

(schedules may be subject to change due to airline schedules)

Application packet, background verification, and $300 deposit are due on or before April 1, 2000

1. The $300 deposit, non-refundable if accepted for the non-paid position of teacher, will be applied toward your airfare and to reserve your place as a KSEN team member. KSEN will pay forty percent (40%) of your airfare and travel expenses up to $2000 from San Francisco to the Mongolian camp and return to San Francisco. You will be responsible for any additional expenses.

2. Background verification. Request this form from KSEN at the address below. Please allow two months for this process.

3. Emergency evacuation insurance required before trip.

4. Complete immunizations, as required before trip (check with your doctor).

_________________________________________________________________________________________

Please mark the teacher position you are applying for:

___art teacher ___new media teacher ___outdoors activity leader

_________________________________________________________________________________________

Personal Information

Name_______________________________________________________Birthday___________

Address_______________________________________________________________________

______________________________________________________________________________

Mailing Address if different from above______________________________________________

_____________________________________________________________________________

Home phone (_____) ______________ e-mail address ______________________________________

Sex_____ Height_____ Weight_____ Social Security Number________________________________

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).

Employer or School_______________________________________________________________

Address of work or school___________________________________________________________

Phone of work or school (__) _________________________________________________________

Emergency Contact

Name________________________________________________________________________

Relationship___________________ Home Address_____________________________________

_____________________________________________________________________________

Work Address__________________________________________________________________

______________________________________________________________________________

Home Phone(_____) _____________ Cell Phone(______) ______________________

Work Phone(_____) ____________ E-mail address___________________________

Medical Conditions

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 or Foods____________________________________________________

Diabetes________ Epilepsy__________ Asthma__________Allergies__________________________________

Other_________________________________________________________________________________

Loss of Consciousness (explain and give date)_______________________________________________________

Corrective Lenses___________ Date of last physical examination___________________________

Along with this application, please provide the following:

1. Three reference letters from those who have known you for at least one year.

a _____________________________________________________________________________________

b______________________________________________________________________________________

c_____________________________________________________________________________________

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 three reasons why you would like to participate in this expedition; c) give three reasons why you think you would make a good KSEN team member

3. A photo of yourself to be put on KSENŐs website.

Conditions

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 teacher volunteer to withdraw at any time if conduct or behavior jeopardizes the welfare of the children or fulfillment of the objectives of the project. Additional travel costs due to early dismissal will be paid by the volunteer teacher. 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.

Signature___________________________________________________________________

Print Name________________________________________________________Date_____________

Please send application packet 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:lettrick@csen.org