Form United for America 2 by 71VH0PK

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									                                        AMERICAS PARALYMPIC COMMITTEE

                                                  “UNITED FOR AMERICA”

                                                VOLUNTEERING APC FORM

Instructions:   this form must be fill out by the aspirant and send to the following email volunteersapc@gmail.com, please attache photo
                             with white background, type passport without cover the face neither accessories




                                                PERSONAL INFORMATION
    Family name                        Family Name 2                          Given name:                       Given name 2:


     ID Number                           Expiry Date:                          Passport N°                       Issue Date:


     Nationality                                 Place and date of birth                                  Day    Month         Year


 Single         Married         Separated                Other


 Height         Weight                                            Body Signs or Body Marks


 Residence country                          Home Address                                    City                Phone number


                                E-mail:
                 In case of emergency call to                                                  Phone and Cell number


                                                   FAMILY INFORMATION
       Father Name                                   YES       NO                         Phone and Cell number


      Mother Name                                    YES       NO                         Phone and Cell number


                                                 MEDICAL INFORMATION
¿ Do you have any sickness?                                      YES              NO               ¿Which?
¿ Do you take medicine?                           YES      NO         ¿Which?
                                                                         Physical
                                                                         Hearing
¿ Are you a disable person?                        YES     NO            Visual
                                                                         Cognitive
                                                                         Cerebral Palsy
¿ Do you use outside help to move more            YES
                                                           NO         ¿Which?
easily?
¿ Do you need constant companion?
                                                  YES      NO         ¿Which?
(Assistance in cleaning activities, mobilize?
                                      PERSONAL REFERENCES
                       Names                                           Ocupation


    Place of residence (Country, City, Address)                      Phone number
                                                                              0
                       Names                                            Ocupation


     Place of residence (Country, City, Address)                      Phone number
                                                                               0
                                     ACADEMIC INFORMATION
                   YEAR OR YEAR
   STUDIES                                 TITLE                INSTITUTION                CITY
                         END
                          0




    Foreign
                  Read     Speech     Write                     Specialty systems
  Languages
                                                    Word   Excel       Power Point        Acces
                                                                    Internet
                                                Other:


   Native
 Language:
                                SPORT PARALYMPIC INFORMATION
¿ Do you know, what is Paralympic Sport?                                           YES     NO
¿ Do you know the Paralympics Sport structure?                                     YES     NO
¿ Do you know, what is maximum organization of Paralympic Sport in the
                                                                                   YES     NO
world?

¿Which one?
¿ Did you know the Americas Paralympic Committee?                           YES          NO
¿ What do you know about the Americas Paralympic Committee?


¿Do you know the development of Paralympic Sport in your Country?           YES          NO
¿Do you know the body in charge of Paralympic Sport in your country?        YES          NO
¿ Which one?
¿ Would you like to learn about Paralympic Sport?                           YES          NO
Why?
¿ Which Paralympic Sport would you like to learn?
                                   VOLUNTEER INFORMATION
¿ Have you ever been volunteer?                                           YES            NO
                                                      Less than one
                                                      year
                                                      Between one
                                                      and three years
       ¿ How long have you been volunteer?            Three to five
                                                      years
                                                      More than five
                                                      years
                                                      I was not
                                                      voluntary
                                                       Social
                                                       Cultural
  ¿ Which areas have you worked as volunteer?
                                                       Sport
                                                       Health
                                                      Marketing and/or Communications
                                                      Protocol and/or Public Relations
  ¿ Which area would you like to work in as APC       Logistic (Transport, Hotel)
                    volunteer?                        Doping Control / Medicine,
                                                    Physiotherapy
                                                      Bilingual Communication / Attachment
                                                      Half time
                                                      Time complete
                                                      Morning
          ¿ What is your available time?
                                                      Afternoons
                                                      Weekends


¿ What knowledge and/or skills may you provide to the APC Volunteer?




¿ Why do you want to be an APC volunteer?
¿ What are you expectations as APC volunteer?




If you want to participate in the launch event at the 1st Americas Paralympic Summit Bogota 2012
from May 27 to June 2 add in subject - Launch Event and send it from April 24 to May 4. Only 40
positions are available for this event.




                Americas Paralympic Committee Website: www.americasparalympic.org


                   Apcamerica, Grupo Voluntariado APC          @Apcbroadcast


                                          volunteersapc@gmail.com

								
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