If you wish to apply please complete this form in as much detail as possible to help us work how best to place you.
Please complete the application form as fully as you can. Do call or email if you have any questions.
All fields marked with an asterix * require you to fill them in.
Surname *
Forenames (as shown on your passport)*
Name as you would like to be known *
Address1 *
Address line 2
Town/City *
County *
Country *
Postcode *
Telephone *
Mobile (optional)
Email
Date of Birth * dd 12345678910111213141516171819202122232425262728293031 / mm 123456789101112 / 19 yy 939291908988878685848382818079787776757473727170
Age at time of Departure *
Full Name (including title)*
Daytime tel number*
Relationship to you *
Nationality *
School/College/University*
Address Line 1*
Address Line 2
Town*
County*
Postcode*
Tel Number
Name of Head of Sixth Form/tutor (if known)
GCSE's
A levels
Degree
List any paid jobs you have had (including job title and dates)
What are your plans after your year out?
Go to university yes no
Go in to a career yes no
Other (please state below) yes no
Other
Can you speak another language? (please state)
To what standard do you speak the language?
What strengths and relevant experience can you offer? Eg childcare *
Please list interests, sports music etc and give details of any clubs and organisations that you belong to.*
Which continents, excluding Europe, have you visited?
Africa yes no
Asia yes no
Australasia yes no
North America yes no
South America yes no
Have you any medical disorders? yes no
If yes please give details?
Are you taking any regular medication? yes no
Have you any allergies? yes no
Have you any dietary requirements? yes no
Have you a previous criminal record? yes no
Have you ever been CRB checked? yes no
For Canada applicants your referee should ideally be a past/present employer.
Title * Title MrMrsMissDoctorProfessorMr and Mrs
First Name *
County
1st Choice Destination * First Destination BrazilCanada - BanffCanada - TremblantCanada - WhistlerChileKenyaNepalRomania - ChildcareRomania - BearsTanzaniaZambia
Why have you chosen this destination?
2nd Choice Destination * Second Choice BrazilCanada - BanffCanada - TremblantCanada - WhistlerChileKenyaNepalRomania - ChildcareRomania - BearsTanzaniaZambia
Departure Month * Select Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
Departure Year * yyyy 2007200820092010
Placement Length * Placement Length 1 month(s)2 month(s)3 month(s)4 month(s)5 month(s)6 month(s)
Price *
Please click here for out current price listing
How did you hear about us?* Hear Net surfingVia Gapyear.comYear out groupFamily & FriendsTalk at schoolGap Year Guide bookReferred by another organisationInformation from Careers serviceTeacher at schoolKnowing returned volunteerResponsible travelOtherWorkthing
Once we receive your application we will contact you to invite you to our office for an informal interview & briefing. If this proves too difficult to attend in person we will be happy to interview you over the phone.
