South- North Volunteer Programmeme of

United Evangelical Mission

Application Form

Name of Church:     

Contact:      

With this application form, the applicant is applying for a development

Volunteer Service in Germany in a church-related work field, but not in a
missionary. Placements might be in youth centres, in schools, in
kindergartens or in organisations with a focus on disabled people, adult
education, working with refugees or elderly people.

Data Protection
We inform you that your personal data will be stored and processed as far as this is
necessary for the implementation of our volunteer programmeme. United Evangelical
Mission (UEM) is entitled to pass on data to Engagement Global gGmbH and by doing so to
other parties. The latter include offices directly entrusted with the implementation of
weltwärts, the German Federal Ministry for Development and Cooperation (BMZ) and other
government agencies. The data is used for the proper processing and accounting of the
approved measure, the safety of the volunteers in Germany, reporting to various federal
offices and, if necessary, inviting volunteers to events within the framework of the weltwärts
programmeme.

Furthermore, the data will not be passed on or sold to third parties. Access to the data is
reserved for UEM employees.

Deviating from this, a transfer of personal data to third parties is only permitted, if they
have been commissioned by UEM to perform (partial) tasks on behalf of UEM. In this case,
third parties are subject to the same data protection policy as UEM.

Applicant:

Family name:      

Given name:      

1
 Street address (for courier deliveries):
     
     
     
Home Address (as written in ID card or passport):
     
Phone:
     
     
Fax (if present):
     
E-Mail:
     
Date and place of birth:
      ,      
Nationality:
     

Marital status (single, married, divorced, widowed):

     
Names/ages of children:
     
Names/ages of person who depend on you financially:
     

Passport

Passport number:
     
Name as it appears in passport
     
Date and place of issue:
     
Valued until (at least until Aug. 2020):
     
Important: Please submit photocopies of the pages in your
passport to include photograph, personal details and dates of
issue and expiry.

Health

2
 How would you describe your general health?
     
Date of last medical check-up
     
Are you physically challenged?
We strongly encourage disabled people to apply for the programme. Please inform us about your challenge so
that we can arrange the placement etc. accordingly.
     

Do you have a history of chronic illness?

     

Education

Name and place of schools attended (with dates)

     

Places of further education (with dates)

     

Finished degree (University) or professional education

     

Other courses or Education/ Exams passed (with dates)

     

Language(s)

Mother tongue(s):
     

How well do you speak English?

Very Good
Good
Moderate
Little
None

3
 How well do you speak French?
Very Good
Good
Moderate
Little
None

How well do you speak German?

Very Good
Good
Moderate
Little
None

Name any other language you can speak:

     

Interests

What are your main interests in school/work/university?

     

What are your chief interests outside your study/work?

     

Profession

Please give a detailed description of your current occupation/job/course of

study:
     

Please list all employment since school (if there is):

     

What would you like to study/work after your voluntary service?

     

4
 Church membership

Of which local church are you presently a member?

     

In what ways have you been involved in youth-work and/or other work in
the church?
     

What do you know about UEM and the involvement of your church in the
organisation?
     

Please enclose a reference with information about your personal

suitability by a pastor or church worker (no relatives and family
members!)

Motivation

How did you hear about the South-North Volunteer programmeme?

     

What is your motivation for wanting to participate in the UEM South-North

Volunteer programmeme?
     

What kind of competences would you like to learn during your volunteer
service?
     

Further wishes

In what area of work would you like to serve during your voluntary service?
     

5
Is there any area of work you are not interested in?
     

Date and place:

     
Signature of applicant: