Maison de la Gare VOLUNTEER REGISTRATION FORM. Who are we?

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1 Maison de la Gare Parce que les Talibés d aujourd hui sont les Hommes de demain VOLUNTEER REGISTRATION FORM Please include with your application a Letter of Motivation, explaining why you want to be a volunteer with Maison de la Gare, and what characteristics and experience will make you a competent volunteer. You can include your professional experience, your plans for the future, and your present activities All volunteers must be 18 years of age on their day of departure. Submit your complete application by to info@mdgsl.com. Avenue Charles De Gaulle Face au stade Maitre Babacar Seye Balacos, Sor Saint-Louis, BP 150, SENEGAL Tel.: info@mdgsl.com Website: Join our Facebook group: Maison de la Gare - Venez en aide aux enfants des rues du Sénégal Who are we? Maison de la Gare is a local Senegalese development initiative. The organization makes it possible for Talibé children to have access to education, health care, sports and other activities. Maison de la Gare is also a leader in lobbying for the Talibé cause, an issue which is gaining increasing visibility in both Senegalese political debate and at the international level. In order to achieve its objectives, Maison de la Gare s team has established and gives high priority to nurturing strong relationships with Senegalese authorities and, even more important, with the Marabouts who are the key to bringing about real change. Maison de la Gare www mdgsl com info@mdgsl com 1

2 VOLUNTEER Name: Family name: Date of birth (dd/mm/year): Sex : M F CONTACT INFORMATION Permanent address: City, Postal code: State / province (if applicable), country: Telephone number (with area code) : Skype address: What method of contact is best for you? Passport number: Do you have a criminal record? If yes, please specify what? PERSON TO CONTACT IN CASE OF EMERGENCY Complete name: Complete address: Telephone number: Relationship to the volunteer: ABOUT YOU Profession or area of study: Languages spoken: French: mother tongue fluent average some knowledge English: mother tongue fluent average some knowledge Other: 2

3 Have you had previous volunteer experience? If yes, please explain (organization, mission, duration, countries, impressions): Describe briefly your previous experience (tasks, responsibilities, working alone or in a team.): What personal interests do you have outside of school and/or your work? Concretely, what do you believe that you can bring to Maison de la Gare? Have you been in Africa previously? If yes, what impressions did you have? REFERENCES Contact information of two people (employer, teacher or other responsible person) whom we can contact who would be able to recommend you: Full name: Profession: Relationship to you: 3

4 REFERENCES (CONTINUED) Full name: Profession: Relationship to you: VOLUNTEERING WITH MAISON DE LA GARE Which program would you like to participate in: Health Care and Hygiene Education Gardening and Site Development Sports Art, Music and Excursions Which living arrangement do you select? Host Family Small Hotel (auberge) If you have chosen a host family, do you have particular requirements which should be taken into consideration in choosing a family? Do you have particular medical needs and/or food allergies? If yes, please specify: YOUR REGISTRATION Expected arrival date: Planned length of stay (1 to 6 months; an extension is possible): Total fee required (please see Volunteer Program Fees ): 4

5 To register, please complete this Registration Form, print it, scan it and return it to us at along with: your CV, and a letter of motivation. Within 15 days of receiving your complete application, we will confirm to you your registration as a Maison de la Gare volunteer. Then, to confirm everything, please send us right away at info@mdgsl.com: the Volunteer Waiver (print it, sign it, scan it), and the deposit of 15% of your total fee (payment details are below) As soon as you have purchased your airplane ticket, please let us know your exact travel plans including dates of arrival and departure. The remaining 85% of your total fee must be paid one month before your arrival, by bank transfer (see below). We look forward very much to welcoming you at Maison de la Gare! WIRE TRANSFER DETAILS: Beneficiary: Maison de la Gare Balacos, Sor, Saint-Louis B.P. 150 Saint-Louis Nord Sénégal Bank Account: Banque Atlantique ave. Charles-de-Gaulle Sor, Saint-Louis, Sénégal SN Bank Account No.: SWIFT Code: ATSNSNDA 5