Graduate Application Form

Title Please selectDrMissMrMrsMsSir

Full Name

Forenames *

Initials

Surname *

Date of Birth: * Day Day12345678910111213141516171819202122232425262728293031 Month Month January February March April May June July August September October November December Year Year1997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970

Nationality *

Religion

Dietary Requirements (eg Vegetarian)

Home Address:

Address 1*

Address 2

Address 3

Town*

County

Postcode

Country Albania Argentina Armenia Australia Austria Bangladesh Belarus Belgium Bolivia Bosnia Brazil Bulgaria Cambodia Canada Chile China Colombia Costa Rica Croatia Cuba Cyprus Czech Rep. Denmark Ecuador Egypt El Salvador Estonia Finland France Germany Greece Guatemala Haiti Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Kuwait Latvia Lebanon Liechtenstein Lithuania Luxembourg Macedonia Malaysia Malta Mexico Monaco Morocco Myanmar Nepal Netherlands New Zealand Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Romania Russia Saudi Arabia Singapore Slovakia Slovenia South Korea Spain Sri Lanka Suriname Sweden Switzerland Syria Taiwan Thailand Turkey U. A. Emirates Ukraine United Kingdom Uruguay USA Uzbekistan Venezuela Vietnam

Telephone *

Mobile

Email * Please make sure email is correct

University Address:

University Name *

Address 1

Address 2

Town *

County

Postcode

Country Albania Argentina Armenia Australia Austria Bangladesh Belarus Belgium Bolivia Bosnia Brazil Bulgaria Cambodia Canada Chile China Colombia Costa Rica Croatia Cuba Cyprus Czech Rep. Denmark Ecuador Egypt El Salvador Estonia Finland France Germany Greece Guatemala Haiti Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Kuwait Latvia Lebanon Liechtenstein Lithuania Luxembourg Macedonia Malaysia Malta Mexico Monaco Morocco Myanmar Nepal Netherlands New Zealand Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Romania Russia Saudi Arabia Singapore Slovakia Slovenia South Korea Spain Sri Lanka Suriname Sweden Switzerland Syria Taiwan Thailand Turkey U. A. Emirates Ukraine United Kingdom Uruguay USA Uzbekistan Venezuela Vietnam

Telephone

Parents' / Guardians' Details:

Title * (Mr, Mrs)

Forenames

Initials

Surname *

Address 1

Address 2

Address 3

Town

County

Postcode

Country Albania Argentina Armenia Australia Austria Bangladesh Belarus Belgium Bolivia Bosnia Brazil Bulgaria Cambodia Canada Chile China Colombia Costa Rica Croatia Cuba Cyprus Czech Rep. Denmark Ecuador Egypt El Salvador Estonia Finland France Germany Greece Guatemala Haiti Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Kuwait Latvia Lebanon Liechtenstein Lithuania Luxembourg Macedonia Malaysia Malta Mexico Monaco Morocco Myanmar Nepal Netherlands New Zealand Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Romania Russia Saudi Arabia Singapore Slovakia Slovenia South Korea Spain Sri Lanka Suriname Sweden Switzerland Syria Taiwan Thailand Turkey U. A. Emirates Ukraine United Kingdom Uruguay USA Uzbekistan Venezuela Vietnam

Telephone *

Mobile

Email Please make sure email is correct

Preferences - Enter your preferences in order of priority (i.e. 1, 2, 3) giving ideally three choices:

Departure Dates:

You can choose:

Africa:September, January, late April

China:February, September

Thailand:October, January, May

India:October, February, April

Nepal:October, January

Mexico:October, February

Community-Environment-Conservation (Kenya & Uganda):October, February, May

Timing Priority and Country Priority

Personal Information - Please answer the following questions which will help us place you in a suitable school or project:

Full Name * (as shown on passport)

University

Date of Leaving University *

Day Day12345678910111213141516171819202122232425262728293031 Month Month January February March April May June July August September October November December Month Year2015201420132012201120102009200820072006200520042003200220012000

A Levels, IB, Highers or equivalent subjects/grades

Degree course & future occupation

Languages

Name & Address of your tutor (for a reference)

List your hobbies & interests (including sports)

List other achievements (expeditions, award schemes, leadership, etc)

Overseas experience

Teaching Only. List the subjects and/or sports you would prefer to teach

State of health (disabilities or recent illness)

How did you hear about us?

Careers Dept

Careers Fair

Which Career Fair?

Careers Talk

Publications

Which Publications?

Website

Which Website? Please select GoogleYahooMSNYear Out GroupVolunteering in AfricaGap Year DirectoryOther Site

Friends

Would you like a large AV Brochure? Please select Yes pleaseNo thanks I already have one

Would you like an Aventure DVD? Please select Yes pleaseNo thanks I already have one

Explain your reasons for wanting to participate in the AV Scheme

Data Protection Act. AV is registered under the Data Protection Act. From time to time we need to pass personal data to our offices overseas and to your project in order that they may look after you appropriately. We would like your consent to this.

I consent to AV offices, in UK and abroad, and my project hosts, holding my personal data.

Please tick to confirm that you are ready to send this form *