Volunteer in Brazil - Sign-Up with Iko Poran | Iko Poran

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We do not charge any subscription fee. Therefore we ask you to only sign up if you are really sure that you want and can take part in an international volunteer program in Brazil. Your subscription already incurs in some costs to analyze and develop our communication.
Please download and print the Iko Poran International Volunteer Agreement. Your application will only be considered after we receive by fax (55.21) 3852.2917 or mail the signed agreement.

After we receive your application form and the signed volunteer agreement, someone from our team will contact you to guide you through the next procedures to format your unique, productive and rewarding volunteer experience.

Fields marked with ( * ) are required..

Program Info

Program Start Date in 2010:

or

Program Start Date in 2011:

N of weeks:

Personal Info

Name ( * )

Last Name: ( * )

How do you prefer to be called: ( * )

Name (as written in your passport):

Contact Information

Email: ( * )

Phone (at home):

Mailing address:

City:

Zip Code:

State:

Country:

Birth date: ( * )

Gender: ( * )

Male

Female

Nationality: ( * )

Present Occupation:

Information required for the Program:

Do you have a valid passport?

Yes

No

Passport valid until:

Passport #:

I.D:

Have you ever been to Brazil?

Yes

No

If yes, please indicate the purpose of your trip:

Please list countries of previous international journeys:

Country and purpose of the trip:

Country and purpose of the trip:

Country and purpose of the trip:

Country and purpose of the trip:

Language abilities

Native Language:

English:

Portuguese:

Others:

How did you learn about volunteer work in Brazil?

Do you have any dietary restrictions we should know about?

Current and prior experience

Prior volunteer experience:

Education

High School:

College (institution and year):

Major:

Post-Graduation/ MBA

Please describe any other relevant educational experiences:

Personal Referencies

1) Name:

Phone:

Email:

Abilities and Interests

Pleas list your abilities.

We will develop a work plan for you based on the form.

Please fill in your abilities below:

Health:

Hygiene Education:

Therapeutic Work

Physical Therapy / Physiotherapy:

Recreation:

Prevention DST:

Rhythmic Dance / Aerobics Exercises

Medicine

If you are a doctor, please fill in your specialization:

Education

Informal:

Sports:

What kind of sport disciplines?

Language abilities:

Please specify:

Others:

Please specify:

Do you have more ability to work with:

Children

Adults

Technical Knowledge

Activities to generate income (Sewing, Mechanics etc.).

Business Plan (Small Business)

Computing:

Fundraising:

Marketing:

Publicity:

Beauty Salon:

Photography:

Others:

Please specify:

Arts and Crafts

Dance:

Theater:

Poetry:

Music:

Circus:

Graphic Design

Painting and Design:

Marché Paper:

Sculpture

Paper craft:

Other Abilities:

Please specify:

Office Work:

Would you like to work in our office:

would rather not

would accept

would rather work

List more abilities not mentioned above:

Interests

Please list the abilities you are most interested in sharing

Interest 1:

Interest 2:

Interest 3:

Are you willing to work in any area you may be needed?

Yes

No

If “Yes”, then we will feel free to place where we need you.

Please list any other impotant factors or make comments.

What is your primary motivation for participating in our pro ( * )

Health and Emergency

Blood Type:

Do you have any MEDICAL CONDITION(s) - such as allergies?

Yes

No

If "Yes", please specify condition(s):

Do you have deficiencies (visual, auditive or other)?

Yes

No

If "Yes", please specify condition(s):

Do you have a history of mental or emotional instability?

Yes

No

If "Yes", please explain:

Are you currently under medical treatment?

Yes

No

If "Yes", please explain:

Do your medical condition(s) require special arrangements?

Yes

No

Iif "Yes", please explain:

Do you require any medications on a regular base?

Yes

No

If "Yes", please list the medications(s) of and reason(s)

Personal Physician’s name:

Phone (with country and area code):

24-hour emergency number if available

Contacts in Case of Emergency

Name:

Relationship:

Address:

City:

State:

Country:

ZIP Code:

Day Phone (with country and area code):

Night Phone (with country and area code):

Verify your information

All information provided is correct and true.

Send a copy of this message to yourself

Association Iko Poran

Rua do Oriente, 280/ 201

Santa Teresa

Rio de Janeiro

Tel. +(55.21) 3852.2916

Fax +(55.21) 3852.2917