The Global Xchange Programme

Volunteer & exchange programme for 18-25 year olds

APPLICATION FORM
 Complete and return this form to:
Global Xchange Programme, VSO Bahaginan, Unit 505 Pacific Corporate Center, 131
West Avenue, Quezon City 1105 or email to gxp.fv@vsoint.org
 Completing and returning this form does not commit you to taking part in the
exchange programme
 Make sure you have read through the information material on the Global Xchange
programme before completing this form (How GXP works, .pdf file)

FIRST NAMES DATE OF BIRTH

FAMILY NAME PLACE OF BIRTH

CONTACT ADDRESS NATIONALITY

EMAIL

HOME TEL NO. MOBILE

1. HOW DID YOU HEAR ABOUT THE GLOBAL XCHANGE PROGRAMME?

Please be specific, e.g. if through the Internet, specify the website, if through a friend, specify their
connection to GXP

2. WOULD YOU BE AVAILABLE TO TAKE PART IN THE GLOBAL XCHANGE PROGRAMME FOR AT LEAST 6
WHOLE MONTHS IN 2006 ?

_________________________________________________________________________________

3. ARE YOU? ☐ FEMALE ☐ MALE

4. ARE YOU CURRENTLY:

☐ Working full-time ☐ Training full-time ☐ Studying full-time
☐ Working part-time ☐ Training part-time ☐ Studying part-time
☐ Unemployed ☐ Voluntary work ☐ Looking for work
☐ Other ______________________

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5. PLEASE GIVE BRIEF DETAILS OF WHAT YOU ARE CURRENTLY DOING

6. AT WHAT AGE DID YOU LEAVE FULL-TIME EDUCATION? – if you are still studying or plan to take a year
out please indicate this as well

7. PLEASE GIVE BRIEF DETAILS OF YOUR EDUCATION/EMPLOYMENT BACKGROUND

(Please continue on separate sheet if necessary)

Global Xchange is committed to the inclusion of people from a diverse range of backgrounds in its
programme. We would therefore be grateful if you could answer the following questions:

8. HOW WOULD YOU DESCRIBE YOUR ETHNIC ORIGIN?

☐ Luzon ☐ Visayas ☐ Mindanao

Specify ethnic group Specify ethnic group Specify ethnic group

--------------------------------------- ---------------------------------------- ------------------------------------------

9. DISABILITY
Global Xchange is committed to increasing the participation of disabled people in the programme and is
working to ensure that we are welcoming and inclusive of disabled people.

Do you require GXP to make adjustments or make available any support facility during the assessment
day? (please specify)

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 10. WHY ARE YOU INTERESTED IN APPLYING FOR THE GLOBAL XCHANGE PROGRAMME?

11. WHAT DO YOU THINK YOU COULD BRING TO THE GLOBAL XCHANGE PROGRAMME?
These can include any interests, voluntary or community work experience or personal qualities you have.

12. REFEREES
Please give the names and addresses of two referees. The first referee should be able to comment on
your skills and should be someone whom you have studied/trained under, or supervised your work
(whether paid or voluntary). The second should be someone who has known you well for at least two
years and can comment on you character. Your referees should not be related to you. (The names of
the referees that you have identified here should be the same referees who will accomplish your
reference forms.)
FIRST REFEREE ☐ STUDY ☐ WORK
Name

Address

Postcode Tel/Email

SECOND REFEREE (personal)

Name

Address

Postcode Tel/Email
13. MEDICAL INFORMATION
If you are accepted for GXP you will need to have a full medical examination. This is in order to ensure
that any medical condition you may have can be managed when you begin your volunteer work both here,
in the Philippines, and overseas, and that we can provide the appropriate support to ensure this. The
information you provide below will enable us to begin this process. Our medical Advisor may wish to
contact your doctor (the one who signed your medical clearance/certificate) before or after the
Assessment Day.

If you answer ‘yes’ to any of the following questions, please give details:

a) Have you ever had any major illnesses, operation or accidents? ☐ Yes ☐ No
Details

b) Have you ever suffered from any mental /physical health problems? ☐ Yes ☐ No
Details

c) Are you taking any type of medication, or have you taken any medication in the last 2 years?
☐ Yes ☐ No
Details

d) Do you have any objections or allergic reactions to vaccinations? ☐ Yes ☐ No

Details

Doctor’s Details. The VSO Medical Advisor may need to contact your doctor for more information.

Doctors’ Name .

Address .

Postcode Tel/Email .

14. DECLARATION
Signing this does not commit you to take part. It shows that the information is correct and that you
would like to be considered for a place on the Assessment Day.

All of the above information is, to my knowledge, true and accurate. I give my permission to GXP to
contact my doctor for a medical report before the Assessment Day, if necessary.

Signed _____________________________________ Date ___________________________________________

(Sign over printed name)

VSO will store and process your data in accordance with the requirements of its Data Protection Policy and in
keeping with the Data Protection Act of 1998. VSO may use your details to send you further information
relating to their international development work. If you do not wish to receive any further information from
VSO please tick this box ☐