NATIONAL VOLUNTEER NETWORK TRUST
Hazina Towers, 11th Floor – Monrovia Street
Box 40635 - 00100, Nairobi
Tel. +254 (020) 6750520
Volunteer Registration Form
(Please fill in / type in the shaded areas. Double click boxes to check the correct box in the dialogue box that appears)
Today’s date: 5/25/2010 Ref No. (For official use).
Last name: First: Middle:
Birth date: Sex:
Residential address: ID no.: Phone Number:
P.O. Box: City: Post Code: Email (mandatory!):
What is your area of interest?
Health & HIV/Aids Education Youth Secure livelihood
Which Category of Volunteer? Students/Fresh Graduates Employee Professional Intl
What is your background?
Business & Management Social & Development Health
Do you have working experience?
No, not yet Yes, up to 5 years Yes, more than 5 years
Have you ever received disciplinary action from an academic institution or employer, whether related
to academic misconduct or behavioral misconduct, which resulted in your probation, suspension,
removal, dismissal, or expulsion from the institution or employer?
Have you ever been convicted of a misdemeanor, felony, or other crime?
NAVNET VOLUNTEER APPLICATION FORM [May-10]
Agreement and Signature
By typing my name below, I certify that all information in my application is complete and
factually true. I understand and agree that an offer of admission may be rescinded at any time
should NAVNET determine that I misrepresented or omitted material information from my
I accept that the data be stored in accordance to Data Protection Act.
I understand that I will pay a Kshs 200 annual registration fee that will help to fund NAVNET’s
administration costs. The registration will only be processed when registration fee has been
paid in NAVNET office.
Upon submission of my complete registration form and fee, I will receive an email confirming
I have read the Program Requirements & Details section of this website.
I have reviewed and accept all pre-travel and volunteer requirements discussed on the
Program Requirements & Details section of this website.
I know that NAVNET is not responsible for any security and medical assistance insurance
coverage during any time a referred volunteer assignment. Such coverage is recommended
but private choice of applicants.
I understand that I will be responsible for lodging, travel, food, and any additional expenses
I am aware that NAVNET is only notifying you of volunteer opportunities within your area of
interest. NAVNET does not forward or recommend you to an organisation.
It is the policy of this organization to provide equal opportunities without regard to race, color,
religion, national origin, gender, sexual preference, age, or disability.
I have read and accept the above declarations.
Type Name (Signature):