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Elic China

Register Now

As the saying goes, “Every great journey begins with one small step,” and this registration form is exactly that. Filling out the form below does not obligate you to ELIC in any way, but it is essential in helping both you and ELIC evaluate whether serving with us in Asia would be an ideal fit. After you’ve filled out this form, we will give you a call to discuss possible next steps. Please note that fields marked with * are required.

Title

First Name*

Preferred Name*

Middle Initial

Last Name*

Phone*

Phone Type*

--None-- Home Work Mobile Other

Secondary Phone

Secondary Phone Type

--None-- Home Work Mobile Other

Skype Name

Email*

Secondary Email

Current Address Type*

--None-- Home/Self Home/Parents School Work Other

Address*

City*

State/Province*

Zip

Country*

Permanent Address Type

--None-- SAME AS ABOVE Home/Self Home/Parents School Other

Permanent Street Address

Permanent City

Permanent State/Province

Permanent Zip/Postal Code

Permanent Country

Gender*

--None-- Male Female

Date of Birth*

Marital Status*

--None-- Single Dating Engaged Married Widowed Re-Married Separated

Maiden Name

Country of Birth*

Citizenship*

Denomination (if any)*

Do you have a passport*

--None-- No - I don't have one yet. Yes - and it is valid. Yes - but it has expired.

Expiration Date (if available)

Have you ever been convicted of a felony*

--None-- No Yes

If so, please explain

Please indicate any post high-school education you have received, starting with the most recent.

Name of School*

Degree / hours completed*

Major*

Expected Completion Date*

Name of School 2

Degree / hours completed 2

Major 2

Expected Completion Date 2

Name of School 3

Degree / hours completed 3

Major 3

Expected Completion Date 3

Additional education background

Please indicate any work experience you have had, starting with the current or most recent employment.

Employer Name

Employment Start Date

Employment End Date

Position

Employer Name 2

Employment Start Date 2

Employment End Date 2

Position 2

Employer Name 3

Employment Start Date 3

Employment End Date 3

Position 3

Besides work and school, please indicate any additional commitments/experiences of relevance (clubs, team sports, volunteer work, etc.)

Experience

Experience Start Date

Experience End Date

Number of hours per week

Organization

Experience 2

Experience Start Date 2

Experience End Date 2

Number of hours per week 2

Organization 2

What other responsibilities, activities, or hobbies occupy your spare time?

Other Responsibilities, Hobbies

Have you had any overseas experience? (Note: Overseas experience is not necessary to serve with ELIC.)

Overseas experience*

--None-- Yes No

Country

Length of Stay

Sending Organization

Purpose

Country 2

Length of Stay 2

Sending Organization 2

Purpose 2

Describe any other cross-cultural or team-related experiences you have had.

Cross-culture, team experience

Second Language

Length of Study

Proficiency

--None-- Beginner/Novice Intermediate/Moderate Advanced/Fluent

Additional Second Language

Length of Study 2

Proficiency 2

--None-- Beginner/Novice Intermediate/Moderate Advanced/Fluent

What is your motivation for wanting to go to Asia at this time? How does this fit with your long-term goals?

Motivation/goals for volunteering*

Preferred Location of Service*

--None-- Wherever I'm needed China Laos Mongolia Undecided

Prefer to be teamed with someone? Who?

Additional Comments

Program year of interest*

--None-- 2012 2013 2014 2015 2016

How did you hear about ELIC? Please be as specific as possible (friend, professor, alumnus, event, advertisement, websearch, etc.), and if you’ve heard through multiple sources, please include each of them, beginning with the first.

How did you hear about ELIC

Program:

STP

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