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Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Artistic

Please explain your arts training:

Please describe your current use of the arts:

(Don't forget that BuildaBridge defines the creative arts very broadly.)

What are your artistic disciplines and/or areas of interest?:

Please list all areas within each category that apply: MUSIC: Woodwind, Brass, Percussion, Strings, Guitar, Piano, Jazz, Blues, Gospel, CCM, Classical, Rock, Hip-Hop, Country, Ethnic(define), and/or Improvisation DANCE: Ballet, Jazz, Hip-Hop, Step, African, Asian, Latin, European, and/or Other Ethnic (define) DRAMA: Spoken Word, Story Telling, Improvisation, Shakespearean, Theater of the Oppressed, and/or Other (define) VISUAL ARTS: Paint, Murals, Fabric, Clay, Stone, and/or Other (define) CULINARY: Nutrition, Generalist, Pastry TECHNOLOGY: Web design, Office, Photography, Video, Film, HTML, and/or Other (define) THERAPY: Movement, Visual, Clay, Music, Drama, Drumming, and/or Other (define) ARTS BUSINESS: Marketing, Development, and/or Web Sales COMMUNITY and ECONOMIC DEVELOPMENT Put each item on a separate line or separate them by commas. No HTML allowed.

Have you ever provided arts training?:

If yes, in which area(s) and for how long?

Have you ever worked with children?:

If yes, in what area(s) and for how long?

Confidential

Insurance Company:

Please write the name of your health insurance company. This is for travel purposes. The content of this field is kept private and will not be shown publicly.

Insurance Number:

Please write you medical insurance number. This is used for travel emergencies. The content of this field is kept private and will not be shown publicly.

Please list two references:

Personal or professional (not relatives). Also provide their relationship to you, their phone number, and their email address.

Passport Number:

This is your current passport number The content of this field is kept private and will not be shown publicly.

Involvement

Your Program of Interest:

Check the primary area in which you are interested in becoming involved with BuildaBridge.

In what capacity would you most like to be involved with BuildaBridge?:

Please select one.

Are you interested in working with BuildaBridge as a(n):

Please selection one.

Please list any relevant training/education, volunteer or work experience that will be useful in working with BuildaBridge:

What personal characteristics and background do you have that would make you a good candidate for service with BuildaBridge?:

Please focus on traits that prepare you for the tough environments we work in.

Please list any other cross-cultural experiences you have had:

Include countries visited/ Put each item on a separate line or separate them by commas. No HTML allowed.

As of what date are you available to begin volunteering/collaborating with BuildaBridge?:

What is the length of your availbility and typical schedule?:

Motivation

How did you first hear about BuildaBridge?:

How do you envision your involvement in BuildaBridge?:

What are you hoping to do?

What is your personal mission statement?:

What are your major life goals, plans, etc?

Personal Info

Address:

Include Street Address and City

Country:

Postal Code:

Home Phone:

Cell Phone:

Date of Birth:

Employment Status:

Please select one.

Place of Occupation:

Education:

Please select your highest level completed.

Please List the name of the last school you attended and the dates of your attendance:

Professional Licenses and Certifications:

Please list the type or number of certification, the state in which is it valid (if applicable), the date of receipt, and the date of expiration. Put each item on a separate line or separate them by commas. No HTML allowed.

Have you completed a criminal background check within the last year?:

Please select one.

Have you been convicted of a felony within the past 10 years?:

(According to our policy, a felony record prohibits a volunteer from working directly with children. However, there are many other opportunities to serve with BuildaBridge.)

If you have been convicted, please explain that nature of the charges:

What is your faith orientation?:

Please select one.

What are your foreign language skills?:

Please list the languages you have studied and the level of proficiency. Put each item on a separate line or separate them by commas. No HTML allowed.

Please describe your computer, techinical, and data entry skills:

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