ISV - High School Leader Application 2008

International Student Volunteers
High School Leader Application

Last Name:	First Name:	Middle Name:	Date of Application:

(1) Mailing Address: (number & street)	City:	State:	Postal Code:

(2) Home Address: (number & Street)	City:	State:	Postal Code:

Phone Number: (work/home)	Mobile Number:	Date of Birth

*E-mail Address: required**	Sex:	Age:
	Male Female

Place of Birth	Nationality:	School

Current & past forms of employment:

Work References: Please provide phone numbers for at least two work related referees:
Name of Referee:	Job Title of Referee	Company	Phone Number




PLEASE LIST ANY LEADERSHIP EXPERIENCE THAT YOU BELIEVE WILL ASSIST YOU IN THE HIGH SCHOOL LEADER ROLE:

ISV OUTDOOR ADVENTURE TOURS ARE EDUCATIONAL. PLEASE LIST YOUR EDUCATIONAL BACKGROUND PLUS ANY OTHER AREAS OF STUDY &/OR EXPERTISE THAT WOULD BE BENEFICIAL FOR YOU TO LEAD AND EDUCATE STUDENTS ABOUT THE ENVIRONMENT, LOCAL CULTURE AND/OR ECOTOURISM:

OUTDOOR RECREATION/SPORTS EXPERIENCE:

TRAVEL EXPERIENCE: (Please list all foreign countries to which you have travelled, as well as the duration and reason for your stay)

HOBBIES/INTERESTS: Please list activities/interests you enjoy most.

Do you speak any languages other than English?
(Please note level of competence).

Extracurricular activities you are involved in:

Volunteer experience:

Please list some methods that you would use to gather a group for the ISV program:

COUNTRY CHOICE:

Costa Rica	Dominican Republic	New Zealand	Thailand
27 Dec	27 Dec	27 Dec	13 Dec
			27 Dec

Do you speak Spanish? Yes No

If yes, how proficiently? Beginner Intermediate Advanced Fluent

How did you find out about the ISV program?

Assembly Announcement (name of announcer) Teacher (name of teacher)

Flyer Poster E-mail Friend Other

Important Details:
Emergency Contact Name:

Phone:

Do you have any physical disabilities?

If so, please explain:

Yes No

Do you take any prescribed medications?	If so, please explain:
Yes No
Do you have any allergies?	If so, please explain:
Yes No
Are you a competent swimmer?	Yes 50m Unaided 100 Unaided Strong No
Are you willing to undertake a medical exam ?
Yes No
Are you willing to undergo a "Working With Children Check"?
Yes No
Are you First Aid certified?	Expiry Date:
Yes No
Certificate Type:
Are you willing to renew or obtain a First Aid certificate if necessary?
Yes No
FOR ALL APPLICANTS: LIABILITY AGREEMENT: I VERIFY THAT ALL THE ABOVE INFORMATION IS CORRECT.
Signature: Date:
PLEASE INCLUDE A CURRENT COPY OF YOUR RESUME INCLUDING CONTACTS FOR WORK REFERENCES AND A COVER LETTER. THANK YOU FOR YOUR INTEREST IN WORKING WITH ISV.

International Student Volunteers Pty Ltd

AUSTRALIA
Mailing: PO BOX 2169 Bondi Junction, NSW 1355 AUSTRALIA
Suite 25, Level 2 Royal Arcade, 175-181 Oxford Street, Bondi Junction, NSW 2022 AUSTRALIA
Ph: +61-2-9369-5556, Fax: +61-2-9369-5595, email: ozteachers@isvonline.com , web: www.isvonline.com

NEW ZEALAND:
Mailing: P.O. Box 137145, Parnell, Auckland 1151 NEW ZEALAND
Street: Suite 7, Level 3, 20 Augustus Tce, Parnell, Auckland 1151 NEW ZEALAND
Ph: +64-9-379 5938 Fax: +64-9-379 3141, email: ozteachers@isvonline.com, web: www.isvonline.com