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Mandatory fields are marked *
Title Please selectDrMissMrMrsMsSir
Full Name
Forenames *
Initials
Surname *
Date of Birth: * Day Day12345678910111213141516171819202122232425262728293031 Month Month Month January February March April May June July August September October November December Year Year1997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970
Nationality*
Religion
Dietary Requirements
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 *
School Name
School Address 1
School Address 2
School Town
School County
School Postcode
School 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
School Telephone
Title *
Forename
Address 1
Town
Telephone
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
1st Choice 1st Choice Timing Sept-DecJan-MayFeb-JunFeb-JulApr-AugMay-AugOct-Feb 1st Choice Country Africa: KenyaAfrica: UgandaAfrica: MalawiAfrica: TanzaniaAfrica: South AfricaAfrica: EnvironmentAsia: ChinaAsia: ThailandAsia: India - LepchasAsia: India - DarjeelingAsia: NepalMexico
2nd Choice 2nd Timing Sept-DecJan-MayFeb-JunFeb-JulApr-AugMay-AugOct-Feb 2nd Country Africa: KenyaAfrica: UgandaAfrica: MalawiAfrica: TanzaniaAfrica: South AfricaAfrica: EnvironmentAsia: ChinaAsia: ThailandAsia: India - LepchasAsia: India - DarjeelingAsia: NepalMexico
3rd Choice 3rd Timing Sept-DecJan-MayFeb-JunFeb-JulApr-AugMay-AugOct-Feb 3rd Country Africa: KenyaAfrica: UgandaAfrica: MalawiAfrica: TanzaniaAfrica: South AfricaAfrica: EnvironmentAsia: ChinaAsia: ThailandAsia: India - LepchasAsia: India - DarjeelingAsia: NepalMexico
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)
Date of Leaving Education Day12345678910111213141516171819202122232425262728293031 Month Month Month January February March April May June July August September October November December Year Year2015201420132012201120102009200820072006200520042003200220012000
GCSE Subjects, Scottish Standards or equivalent (show grades)
'AS' Levels or equivalent subjects/grades
'A' Levels, IB, Highers or equivalent subjects/grades
Languages
Intended degree course & future occupation
Head of Sixth, Form Tutor or Housemaster/mistress
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
Name the person you wish to be paired with (if applicable)
Careers Dept
Careers Fair
Which Career Fair?
Careers Talk
Publications
Which Publications?
Website
How did you hear about us?
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
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.
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