Community service preliminary form 2012

Page 1

Preliminary Application form

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International Community Service program

INSTRUCTIONS - Fill out and sign the form.

- Attach a cheque or a Money Order for $75 (opening file fee non refundable) payable to AFS Interculture Canada. - Send it to the following address: AFS Interculture Canada 1425 René-Lévesque blvd. West, Suite 1100 Montreal (Québec) H3G 1T7 First name and surname

Gender

Address Telephone (home)

Month

No.

City

Mobile

Birth Date Province

E-mail

Day

Postal Code Postal Box

I'm interested in the following destinations : Year of departure

Summer or Winter departure

How did you hear about AFS Interculture Canada? If you can, give details (for example, if you indicated "Internet", you may add "google search engine", or if you marked "local newspaper", write the name of the paper and the publication date, if you remember it).

I certify that the information submitted on this form is exact.

Candidate's signature

I am interested in obtaining information about volunteering with AFS in Canada. I am interested in obtaining information about hosting an AFS student in Canada.

Date

Year


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