Form Approved – OMB No. 0578-0024 NRCS-PER-002 Exp. Xx-xx-xxxx
THE EARTH TEAM
Volunteer Interest and Placement Summary
A. Name and Address: A. 1. Date: A. 2. Business Telephone Number: A. 3. Home Telephone Number: A. 4. E-Mail Address: B. Have You Ever Done Volunteer Work? (Check one box) B. 1. Where? B. 2. What Kind? C. Education (Check the highest level of education completed) Grade 1 College: 1 D. Occupation: D. 1. Interests, Skills, Hobbies: E. What Type of Volunteer Work Would You Like to Do for Conservation? (Check boxes that apply) Outdoor Activity Computer Public Speaking Office Clerical Photography Writing 2 2 3 3 4 4 5 6 7 8 9 10 11 12 Yes No
C. 1. Degree: ___________________________________________________
E. 1. Other (please specify): ______________________ F. 1. Date of Availability: _____________________________________ F. 2. How Much Time Can You Give? ______ Hours Per: ________
F. What is Your Area of Availability? (Check one box) City County State F. 3. Why Do You Want To Work for NRCS?
G. Are You A United States Citizen? (Check one Box)
Yes
No
International volunteers complete page 2 of this form. G. 1. What type of documentation do you have stating that you are a Citizen or that you have legal entry into the U.S.? (Please Specify) _____________________________________________________________________________
Privacy Act Statement This information is provided to comply with the Privacy Act (PL 93-579). U.S.C. 301 and 7 CFR 260 authorize acceptance of the information requested on this form. The data will be used to contact applicants and to interview, screen, and select them for volunteer assignments. Furnishing this data is voluntary. OMB Disclosure Statement According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0578-0024. The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection.
NRCS-PER-002 Exp. Xx-xx-xxxx
TO BE COMPLETED BY INTERNATIONAL VOLUNTEERS ONLY 1. Provide contact information (name, address, phone number, fax number e-mail address) for your supervisor, major professor, or another individual that we may contact:
2. Planned dates for your visit: Arrival: _________________________ Departure: ____________________________ 3. Home Country: _________________________________________________________________________________ 4. Reason for visit to U.S.: __________________________________________________________________________ 5. Goals and objectives for volunteering: _______________________________________________________________ If you do not have a visa, we recommend you visit your Embassy and seek a visa that will allow you to do the kinds of things you wish to do during your visit. Once obtained, we can continue with making arrangements. If the Embassy asks for a letter of invitation, the USDA-NRCS is prohibited from issuing letters of invitation. If you have any question regarding obtaining a visa and planning a visit with NRCS, please contact the USDA-NRCS International Programs Division at (301) 504-2271.