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Personal Details

Full Name*

Date of Birth*

Gender
 Male Female

Full Address*

Nationality*

Skype Name

Email*

Occupation*

Educational Background*

Please list two Emergency Contacts?*
Name - Relation - Email - Phone

Volunteer Experience

Do you have any experience with the following? If so please briefly describe.*

 Volunteer Experience Living in Developing Countries Tibetan Buddhism Film, Photography or Media Teaching Medical Art, Music, or Dance Working with NGOs Fundraising Tibetan Language Nepali Language

Please detail what you checked above or write any other relevant experience here.

Medical & Safety

(This information will remain confidential with Helambu Project but must be disclosed for safety reasons. Please see the medical section of the Volunteer Field Manual for more information.)

Do you have any medical conditions or allergies? If yes, please also describe reaction and proper response.

Do you have any psychological conditions (anorexia, depression, etc.) or have you seen a counselor in the past 2 years? If so, please briefly (without detail) describe what for.

Do you have a criminal record or have you been ever convicted of a crime?
 Yes No

Describe your level of physical fitness. Are you able to walk uphill for several hours carrying a pack? Do you have any trekking / mountain experience? It's not required but it does help determine your school placement.*

Motivation & Interest

Please respond to the following quote. (Best answers will be posted on our volunteer section)*

“If you have come to help me because you feel called to help me, you are wasting your time. But if you have come because your liberation is bound up with mine, please stay and let’s work together.” ~ Lilla Watson

What are you most excited about?*

What are you most anxious about?*

When would you like to come?*

How long would you like to volunteer for?*

Are you interested in being part of our Education+ or helping develop curriculum for our Education+ program? (Relevant experience required - read more about this project under projects)
 Yes No

Other

Is there anything else you feel we should know about you, that you would like to tell or a question you would like to ask?

Where did you hear about us from? (If from the internet, please say which site referred you)*

Would you like to be part of our newsletter?*
 Yes No

* denotes a required field