Land and Culture Organization
Campaign Volunteer Application

General

Full Name:
Social Security #:
Sex: Male Female
Citizenship:
Place, date of birth:
Passport Number:
Passport Expiry Date:
E-Mail Address:
Current mailing address:
Number and Street:
City, State, Zip:
Home phone:
Work or school phone:
Permanent mailing address:
Number and Street:
City, State, Zip:
Home phone:
Work or school phone:
Are or have your been a member of Land & Culture Organization? Yes No years

Have you been a volunteer for an LCO summer campaign? Yes No
If so, please give year and location:

How did you hear of LCO? (If through a friend or family member, please provide name):

Do you have any relatives or friends that may be interested in future LCO campaigns? If yes, please give names and addresses:

Check appropriate levels of your knowledge of the Armenian language:
  None Basic Good Fluent
Speaking 
Reading 
Writing 

List degree of skills in other languages:

List foreign countries, in which you have lived and/or traveled. Give dates, duration, and purpose of travel:

Education:
Beginning with the most recent, list all schools attended since and including high school. Include any trade or technical schools, military training, etc.
Name of School City & State Dates Attended Major Minor Degree Date received or expected
From: Mo./Yr. To: Mo./Yr.

Employment Record

Please include any self-employment, home management, full or part-time, salaried or volunteer employment. Start with your current and most recent experience and go back five years. Please also feel free to enclose a resume.

Company/Organization:
Title:
City,State,Zip:
Duties & Responsibilities:
From (month/year):
To (month/year):
Work HoursFull Time Part Time
Reason for Leaving:
 
Company/Organization:
Title:
City,State,Zip:
Duties & Responsibilities:
From (month/year):
To (month/year):
Work HoursFull time Part time
Reason for Leaving:

Please describe any active community volunteer and organizational work you have done. Be sure to indicate any position of leadership held and special project responsibilities and achievements:
Name of Organization Positions Held Dates of Involvement

Extracurricular Activities and/or Hobbies
Describe below any hobbies, activities or other interests not elsewhere included. Please include any special skills, which may be utilized in your work as an LCO volunteer:

Personal Health And Medical Information:
Please answer the following questions completely and accurately:
a. Do you have any allergies? Yes No
If so, please list:
b. Have you had surgery within the last year? Yes No
If so, describe nature and dates:
c. Are you currently on any medication? Yes No
If so, list medication and reason:
d. Have you ever been under psychiatric care? Yes No
If so, please state:
e. Please describe below any illnesses, handicaps or other medical conditions that may require you to have a degree of special attention:

Have you ever been convicted of any criminal offense - or have a record of any nature that may prohibit clearance to receive a foreign Visa?

Campaign Information

Indicate the month of your availability for volunteer work: July August Both

Please indicate numerically the order of your preference for the location at which you would like to volunteer: Kessab, Syria     Armenia     Artsakh

Motivational Statement

Please explain why you wish to be an LCO volunteer (the statement need not be limited to the space provided below):

Any Other Additional Information:

Letter of Recommendation: Please list the name of the person who will be writing a letter of recommendation on your behalf:
In case of emergency, please contact:
Name:
Address:
Home phone:
Work phone:
I certify that all of the statements in this application are true, correct, and complete to the best of my knowledge.