MOBILE ART SCHOOL IN KENYA (MASK)

Registered UK Charity No: 1128734

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MASK (Mobile Art School in Kenya)

VOLUNTEERING APPLICATION FORM

Name _______________________________________________________

Gender male __________ female _____________

Contact address _______________________________________________________

__________________________________________________________________________

Contact telephone ___________________________

Email ___________________________

Age ___________________________

Date of birth ___________________________

What do you do/specialise in? ________________________________________________

Your personal qualities and any skills and experiences

__________________________________________________________________________

What is the highest educational qualification you currently have?

__________________________________________________________________________

Are you currently a resident in UK? ________________

Passport details: number, issue date, expire date, issued by

__________________________________________________________________________

Emergency contact person/s, name, address, tel numbers

__________________________________________________________________________

Ethnic origin __________________________

Active religion (if any)? If you don't have one, please put 'none' ________________________

Have you ever been working in Africa before If Yes, please give brief details

__________________________________________________________________________

Which MASK’s programme are you interested in participating?

Working in Sipili schools _____________

Working in Naivasha schools _____________

Building Inchurra _____________

Health and Personal Information

Have you ever had any serious illness? __________________________________________

Do you have any physical limitations? ___________________________________________

Have you ever had any mental or nervous problems? _______________________________

Are you undergoing any kind of medical treatment (including taking pills or drugs)? __________________________________________________________________________

Do you have any allergies? ___________________________________________________

Do you have any dietary restrictions such as vegetarian, halal, etc? __________________

Do you have any medical condition(s), however minor? _____________________________

If you have answered 'Yes' to any of the above please give details

Criminal Record

Do you agree to complete a Standard Disclosure Criminal Records Bureau (CRB) check form, cost £30? ____________________

Have you ever been arrested, convicted or cautioned for any offence (spent or unspent) including driving offences? If yes, please give details, including the dates, offence and penalty. (This information will not necessarily disqualify you. Each application is considered

on its merits) ____________________

Application Declaration

Have you read Terms and Condition? ______________

I understand that if I am accepted onto this programme I will be living in difficult conditions in a developing country. I agree to obey the local law and be respectful of other people’s culture, traditions, customs, religious beliefs and practices. I understand all the details of MASK as given on the website and/or the all documents, and the Terms and Conditions of the programme. I agree to be bound by them and certify that all the statements I have made on this form are true.

Signed: ___________________________________________________________________

Date: _____________________________________________________________________

Please post it to:

Director, Mobile Art School in Kenya (MASK), One, St Paul’s Churchyard, London EC4M 8S

together with £25 administration costs (cheques payable to Mobile Art School in Kenya)

Registered UK Charity No: 1128734