Application Information

*Marked items are not required.

Legal Name

Please enter your legal name
Depart / MM / DD YYYY
Please enter your departure date
Return / MM / DD YYYY
Please enter your return date
Preferred Name
Birth Date / MM / DD YYYY
Birthplace

(city, state)
Are you 18 years of age or older?
Yes No
Citizenship
Social Security Number*

Optional
Gender
Male Female
Martial Status
Single Married
Native Language
Current Address
Current Phone Number
Current Mobile Number
GRAACE can contact me at my current address until
Permanent Address
Permanent Phone Number
Email Address
Emergency Contact

Name
Relationship
Address
Phone
Email
Will you be traveling with a spouse?
Yes No
Children?
Yes No
If yes, how many?

If traveling with a family, we can accomodate children over two years.
Where did you learn about this program?
Overseas Experience

Country Duration Purpose
Do you have a passport?
Yes No
If yes, Passport Number
Passport Issue Date / MM / DD YYYY
Please enter your passport issue date
Passport Expiration Date / MM / DD YYYY
Please enter your passport expiration date
Place of Issue
Please list involvement and achievements that you think will help you be successful in this program. Be sure to include any long-term volunteer service.

Type of Service Description Duration
Please list medical conditions or dietary restrictions
Are you currently on probation, parole, or under restriction with any courts, or have you ever been convicted to a crime (other than a traffic violation)?
Yes No
In the space below please tell us a bit about your background, and explain why you are interested in participating in the GRAACE program and what you feel you can contribute to the program.
Employment Record

Company/Employer Position Supervisor Phone Dates
References

Name Phone Relationship
In order to be considered for a volunteer position in the summer of 2009, you must attend one of two training session. If you plan on volunteering in or after September 2009, choose other. Please choose one.

April 17th-18th
10am-4pm
Boise, Idaho
Location: TBA May 15th-16th
10am-4pm
Salt Lake City, Utah
Location: TBA Other
Program Costs
$1570 to $1585 for one week
$70 to $85 for each subsequent week
$1500 airfare
$10 host family (mud hut-mat on floor)/$25 (running water with bed)
$50 processing fee (or remaining program fee)
$10 bike rental

$1735 to $1810 for one month
$235 to $310 for each subsequent month
$1500 airfare
$25 host family (mud hut-mat on floor)/$100 (running water with bed)
$200 processing fee (or remaining program fee)
$10 bike rental

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