Karama Application

Date of Application

Date of Birth

How long would you like to volunteer at Karama? Please indicate dates.

From:

To: / /

CONTACT EMAIL

TELEPHONE NUMBER

Country of Nationality at Birth	Second Nationality (if any)
Country of Present Nationality	Second Nationality (if any)

City and Country of Current Residence

Marital Status

Single

Married

Widowed

Divorced

In a relationship

Are there any limitations on your ability to engage in all travel? Yes No

Have you ever been arrested, indicted, or summoned into court as a defendant in a criminal proceeding, or convicted, fined or imprisoned for the violation of any law (excluding minor traffic violations)?

Yes No Give explanation of each case:

Have you any objections to our making inquiries of your present employer?

Yes No

NAME OF EMPLOYER

JOB TITLE

MONTH

YEAR

Volunteer Experience (if any):

Please list your skills that you feel are most pertinent to the Karama Organisation:

Please indicate any specific workshops, programmers, lessons or lectures you plan to offer:

Do you have any contacts in Palestine? Yes No

Have you been to Palestine or to the Middle East before? Yes No

If yes, where and why?

REFERENCE NAME

RELATIONSHIP TO YOU

EMAIL ADDRESS

TELEPHONE NUMBER

In case of Emergency, who should we contact?

CONTACT EMAIL

TELEPHONE NUMBER

Please copy this form and paste it into a Word-document and email it to volunteers@karama.org

(For Firefox users: copy the form into a Word-document, then save it as Word 97-2003 document. Now you should be able to type in the boxes)