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Short application for YDP 2012

Peace Corps Azerbaijan


Youth Development (YD) Project
Request for a Peace Corps Volunteer
Submit the completed request form in English before May 15, 2012 to:
Peace Corps Azerbaijan
2c Hasan Aliyev Street
Baku Az1078, Azerbaijan
Or e-mail it to Sevinj Abdullayeva, YD Program Manager and/or Emin Mammadli, Program Assistant at
sabdullayeva@az.peacecorps.gov; emammadli@az.peacecorps.gov
NOTE: This application form is an initial questionnaire. The selected organizations will be asked to complete
a more detailed one.
REQUESTING ORGANIZATION
Name and type (e.g. NGO, Governmental, LLc, etc):
______________________________________________
Region: _______________________________________________________________________
Complete Address:
Office telephone:

__

__Email address:

CONTACT INFORMATION
Head of organization (director, manager, etc)
Name:
Home telephone:

Mobile:

_____

INFORMATION ABOUT ORGANIZATION


Your organization was established in

(year)

Total number of staff:

male

female

How many of the staff speaks English?

_____________________________

Short application for YDP 2012

Please describe the overall purpose of your organizations activities


________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
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Does your organization have the office? If yes, will the PC Volunteer have his/her space to do work at
your office?
_______________

_________

_________________________________

__
_________

_________________________________

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_________

__

Give information about the most recent projects implemented by your organization?
_______________

_________

_________________________________

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_________

_________________________________

__
__

_________

__

What is your organizations funding source and duration of funding?


_______________

_________

_________________________________

__
_________

_________________________________

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_________

__

Has your organization have experience with Peace Corps Volunteer in the past? If yes, please specify
_______________

_________

_________________________________

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_________

__

_______________________________________________________________________________________
Which area do you expect help from Peace Corps Volunteer?
_______________

_________

Short application for YDP 2012

_________________________________

__
_________

__

How do you see your role as a host organization in hosting and working with Volunteer?
_______________

_________

_________________________________

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_________

__

_______________________________________________________________________________________
Please provide us with the information on computer and Internet access available in your community
_______________

_________

_________________________________

__
_________

__

How will the organization, as well as youth in the community, benefit from collaborating with a
Volunteer?

___
___
___
___
____________________________________________________________________
________________________________________________________________________________________

When would you prefer the volunteer to start working at your organization?
December 2012
June 2013

How did you learn about the PC YD Program and opportunities to have a Volunteer? (Please, tick
one)

Newspaper ___ List serve ___ Other PCVs __ PC staff __Other organizations__
Other sources (please specify) _______________________________________
E. REQUIRED SIGNATURE
Head of organization:

Name
Signature
Date

_____________

Peace Corps use only:


Received:
YD Program Manager

Date

Short application for YDP 2012

Reviewed:

_______________________________________
YD Program Manager

____________________
Date

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