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Wide Horizons (WH)Application Form
Test Location: ______________ Test Date: ________________(Date/Month/Year)
Please complete the form and submit to WH staff member on the day of testing.If
you need an application, please email [email protected]
1. Personal Information
Name:
Date of Birth:_______________ Gender (circle 1): Male / Female / Other_____
Ethnicity:
Marital Status:
Phone Number:
Email:
Host Organization:
2. Documentation
Please circle the following identification category that applies to you and attach a copy
of the ID card/document to this application. (Note: You can apply without identification)
a) UNHCR
b) PRE-registration
c) 10 year ID
d) Other
3. What is the highesteducation level that you have completed?
(Note: You can still apply if you have not had formal education)
a) Primary b) High School c) Post-Ten d) University e) Other _______________
4. Burmese Language skills
I can (circle all that apply) speak Burmese / write in Burmese / read Burmese
How would you rate your Burmese Language skills? Please circle one.
a) Advanced b) Very good c) Good d) Basic e) Weak
5. Volunteer, Work, or CBO Experience: Please provide detailed information ofyour present andpast work/volunteer experience in your community.
CurrentOrganization
Start Date
End Date
Job Title
Descriptionof Duties
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5. Volunteer or Work Experience Continued:
Past
Organization
Start Date End Date
Job Title
Description
of Duties
6. Why are you applying for Wide Horizons School?
What are your plans after your 1-year internship with your host organization?
7. Reference
Please give the attached reference form to your supervisorat your
currentorganization to complete about you. *Note: You cannot give this
form to a parent, family member, or friend.
* ()
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Wide Horizons (WH)
REFERENCE FORM (page 1)
)
Candidate name:
_____________________________________________
Referee name/ Title :
_____________________________________________
Organization:
______________________________________________
Contact Details: ______________________________________________
Please complete the following grid for this candidate.
Excellent
Good
Average
Below average
Motivation to learn new things
Critical Questioning Ability
Communication skills Leadership Potential
Management (time, tasks)
Persistence
Self-motivation
Atitude and Enthusiasm
Team work
Interest in community work
Commitment to Organization
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REFERENCE FORM (page 2)
)
Please comment about the candid ate in detai l :
Length of time working at organization: __________________________
Current responsibilities at organization: ( )
Strengths: ( )
Weaknesses: ( )
What I hope the candidate will learn at WH:
WH
Intended responsibilities during internship year(
)
I _________________________ (your name), declare that I am the supervisor of
__________________________ (candidate name), that our organization is willing forthe candidate to attend WH for 10 months, and that we intend to have a job ready forthe candidate when s/he returns for his/her internship at our organization in April.
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/___________________________ ()
/ ________________________ ()
/ WH
( )
Signature ():______________________ Date( ): ____________________
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