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Wide Horizons (WH)

Application Form

Test Location:______________ Test Date:________________

(Date/Month/Year)

Please complete the form and submit to WH staff member on the day of testing.If youneed an application, please email widehorizonsmaesot@gmail.com

. !ersonal "n#ormation

$ame:

Date o# %irth: &ender (circle 1): Male / !emale / "ther

'thnicit:

arital *tat+s:

!hone $+m,er:

'mail:

Host -rganization:

. Doc+mentation

Please circle the follo#ing identification category that applies to you and attach a copy of theID card/document to this application$ (%ote& You can apply #ithout identification)

a) '%H b) P*+registration c) - year ID d) "ther

/. What is the highested+cation le0el that o+ ha0e completed1 (%ote& Youcan still apply if you ha.e not had formal education)a) Primary b) High chool c) Post+0en d) 'ni.ersity e) "ther

2. %+rmese Lang+age s3ills

" can4 (circle all that appl) spea1 2urmese / #rite in 2urmese / read 2urmese

Ho# #ould you rate your 2urmese 3anguage s1ills4 Please circle belo#$e one$a) 5d.ancedb) 6ery goodc) 7oodd) 2asic

e) Wea1

5. 6ol+nteer7 Wor37 or 8%- '9perience: Please pro.ide detailed information of yourpresent andpast #or1/.olunteer e8perience in your community$

8+rrent

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-rganization

*tart Date

'nd Date

o, Title

Description

o# D+ties

1

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6ol+nteer or Wor3 '9perience 8ontin+ed:

st

ganization

art Date

nd Date

, Title

escription

D+ties

h are o+ appling #or Wide Horizons *chool1

hat are o+r plans a#ter o+r ;ear internship with o+r host organization1

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=e#erence

ease gi.e the attached reference form to your s+per0isorat your currentganization to complete about you$ 9Note: You cannot give this form to a parent, familyember, or friend.

!"#$% & ( )*+

"+#$% ,- . ( ) /0%")1 2+ 2

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elf+moti.ation2.7- !:

5titude and *nthusiasm02)7 ,$

0eam #or1/: /;)=

Interest in community #or1/ . & .7

ommitment to "rgani:ation?(;=

3

REFERENCE FORM (page 2)$% ( " C)

Please comment about the candidate in detail:

Length o# time wor3ing at organization: __________________________!"# $%& '

8+rrent responsi,ilities at organization: ( !"#()$* $ +, )

*trengths& ( "=" )

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Wea3nesses& ( "=" )

What " hope the candidate will learn at WH:

WH "&"4/DB E :@"$"

"ntended responsi,ilities d+ring internship ear( > ::04 ; .*=" )

" _________________________ (o+r name)7 declare that " am the s+per0isor o#

__________________________ (candidate name)7 that o+r organization is willing #or thecandidate to attend WH #or ? months7 and that we intend to ha0e a o, read #or the candidate

when s>he ret+rns #or his>her internship at o+r organization in April.

4

:@*/:@*= ___________________________ ( ):@*/:@*= ________________________ ("4/) F(2+:@*/:@*= "4/ WH & 3G

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