PTS APPLICATION FORM

PERSONAL INFORMATION
Full Name: *

First Name Middle Name Last Name
Preferred Name: *
Gender: *

Male Female
Birth Date: *

Month Day Year
Age: *
E-mail: *
example@example.com
Home Number:

Area Code Phone Number
Cell Number: *

Area Code Phone Number
Permanent Address: *

Street Address

Street Address

City State / Province

Postal / Zip Code Country
Facebook Name *
Skype Name
Proposed Date of Arrival *
How long do you want to intern/volunteer? *
How many hours a week are you willing to work?: *
What's your interest field of intern or volunteer? *
Why do you want to volunteer or intern in Ghana and what are your expectations? *
Tell us about yourself *
Do you have any special medical conditions and/or dietary requirement? *
Do you wish to tour other part of the country during your stay? *
EDUCATION
Name of College: *
School Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
College - Year - Major: *
Other College(s) info:
High School - City - Dates:

PERSONAL INFORMATION