SIGN UP WITH RUCHI

1) Personal Details First Name
Last Name
Address
City/State
Country
Postal Address
City/State
Country

(If different than above address)

Email (personal)
Email (work)

(If relevant)

Work Phone
Home Phone

(Contact number while you are away)

Fax
Mobile
Date Of Birth

2) Choice Of Placement Personal Development Placement (3 weeks)

Educational Placement

If Educational, please give an estimate of how many months

Placement Date:

If unable to attend set placements, state preferred dates:

Comments relating to placements:

3) Experience Please give a brief summary of your areas of study and/or work experience:

Please give a summary of your previous travel experience:

Please state your reasons for getting involved with volunteering now:

What are your areas of interest in rural development/ RUCHI’s work:

For our marketing purposes, please tell us how you found out about TOTEM:

4) Terms and Conditions

Please read the RUCHI Terms and Conditions carefully and complete the following:

I confirm that the above is true to the best of my knowledge. I understand that I will only be accepted on the TOTEM placement subject to assessment of this application form and a satisfactory reference if required.

I have read and understood all information in this pack concerning my application, including Terms and Conditions below, particularly with regard to the application procedure and risks and likely conditions at the placement.

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