Issuu on Google+

St Vincent De Paul Society Immersion Program 2006 Participant Application Form

All application forms to be posted, faxed or emailed to: St Vincent de Paul Society, 2010 Immersion Program, PO Box 1468, Nightcliff, NT 0814 Fax: 08 8948 2844 Email: youth@svdpnt.org.au By Monday 11th January 2010 Please complete this entire form to register your interest in participating in the 2010 Immersion Program. All of the information provided by you will remain strictly confidential and will not be passed on by the St Vincent de Paul Society to anyone unless specified by you. Surname: __________________________ Date of Birth: _ _ / _ _ / _ _ _ _

Given Names: _________________________

Gender: Female / Male

State / Territory: ________

Postal address: _____________________________ Suburb: _______________________ Post code: ___________ Email: ______________________________________________ Mobile: ______________ Home No: ________________ How would you prefer us to contact you?

Work No: _________________

________________________________________

Hobbies / Interests: __________________________________________________________ Are you currently a member or volunteer with the St Vincent de Paul Society? Yes / No If yes, when did you start? ____________________________________________________ What Vincentian conference(s) and/or work(s) are you involved in? ____________________ __________________________________________________________________________ Why are you involved with the St Vincent de Paul Society? ___________________________ __________________________________________________________________________ __________________________________________________________________________ Why would you like to take part in the Immersion Program? __________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ What do you hope to get out of this Immersion Program? ____________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________


This is a spiritual program as much as it is a practical program and you will be expected to reflect on your experiences throughout the time. How does this sit with you? __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ What other skills do you have that may be useful? __________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Describe your previous experience with young children. _____________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Describe your previous experience working in a team environment. ____________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Have you ever visited an indigenous community before? If so, please give details. ________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ What activity do you think you could run in the Indigenous Community? _________________ __________________________________________________________________________ How did you hear about the Immersion Program? __________________________________ __________________________________________________________________________ Is there anything else you would like to add that you haven’t covered in a previous question? _________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Details of a referee who knows you from your involvement with the St Vincent de Paul Society (not a family member): Name: ________________________

Role in Vinnies: _____________________________

Contact phone numbers: ______________________________________________________ We may also contact your relevant St Vincent de Paul Society State or Regional office to ask for a reference.


http://vinnies.org.au/files/NAT/Youth/ImmersionProgramNTApplicationForm2010