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Travelling Volunteer Application



Hello and thank you for your interest in volunteering with Knowledge for People! This application is for the Summer 2012 trip to the Maldives where we will be working with the Maldives Autism Association and the community of Male´.

 
First Name:  Last:  Date: 
Phone (xxx-xxx-xxxx):   Email address: 

 
Current Employer: 
Position/Title:    Length of Employment: :
Does your employer require a background check?  
If yes, date of last background check: 

 

List the type of intervention(s) in which you have training:
1:  2: 
3:  4: 
5:  6: 
7:  8: 
What experience do you have training others on any/all above interventions? (Please indicate audience and setting.):
List any certifications, degrees, licensure you hold:
1:
2:
3:
What are your areas of strength are you most capable of training others? (check all that apply)
Social Emotional skills
Communication skills
Sensory regulation and integration
Reducing maladaptive behaviors
Cognitive/academic skills
Visual supports
Augmentative devices
Parent coaching		 Environmental Arrangement/Organization (home and center) 
Feeding Therapy
Life/Adaptive skills
Family/Sibling support
Advocacy
Autism education
Other: 
What ages of individuals with autism have you worked with? 
Years of experience with children with autism: 
What other special needs populations have you worked with?
Cerebral Palsy
Down Syndrome
Rhett Syndrome
Mental Retardation/General intellectual disabilities
Blind/Visually Impaired
Hard of hearing/Deaf
Muscular Dystrophy
  
What, if any, experience do you have traveling to developing countries?
Do you currently have an active passport?   
Have you ever been denied entry into a foreign country? 
If yes, please explain: 
Please provide two references who can speak to your qualifications to train in your area of expertise:
Name:  Relationship to you: 
Phone Number: 
 Email: 
Name:  Relationship to you: 
Phone Number:  Email: