Form PC - 1502 PC - 1502 Peace Corps Volunteer Application

Volunteer Application

OMB: 0420-0005

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0420-0005 can be found here:

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Volunteer

application
www.peacecorps.gov | 800.424.8580

Instructions for completing the application
Thank you for your interest in serving as a Peace Corps Volunteer. Applying to become a Volunteer should be a
thoughtful process of preparing yourself for a 27-month experience that will be life changing for you, for those close
to you, and for the host communities where you will serve.
This application must be typed or completed in black ink.
Please complete all of the sections listed below.
•

Contact and personal information

•

Information about your education, work experience, and other relevant activities

•

Two essays

•

Information about your health through the Health Status Review

•

References from your work colleagues and friends

As you complete the application, please keep in mind:
The application can take up to eight hours to complete. However, you will be able to save your file throughout the
application process and come back later to complete it.
In answering a question, provide information that demonstrates you understand what is expected of you during your
Peace Corps service.
Answer all questions thoroughly and accurately and provide up-to-date information throughout the application process.
We may disqualify applicants if we determine that they have provided misleading, inaccurate, or incomplete information.
The Peace Corps needs Volunteers with specific skills, who are reasonably healthy and can serve where they
are needed. Skills for Peace Corps are acquired through education, professional work experience, volunteer
experience, and/or activities, and hobbies. Complete questions fully to give yourself the best chance for consideration.
Your essays are used by recruiters in determining the best fit for your Peace Corps experience and, if you are selected,
by the country director in your country of service to help determine how best to support you. Take adequate time for
the essays as they are important to you and to us.
Your health is an important component of Peace Corps service. Thus, in order to serve as a Volunteer, you must have
medical and dental evaluations. You will be required to complete a Health Status Review form as part of the application
process. If you are selected for an interview and nominated for service, you will receive additional instructions regarding your medical and dental examinations.
What friends and colleagues say about your qualifications to become a Volunteer is an important part of the application.
You will be asked to provide three references as part of the application.
In order for the Peace Corps to be able to make appropriate selection and placement decisions, it is critical that
applicants provide complete and accurate information throughout the process. You may be disqualified or separated
from Peace Corps service if you provide misleading, inaccurate, or incomplete information during the application
process. Moreover, any intentionally false statement or intentional omission could be subject to fines and/or
imprisonment under 18 U.S.C. § 1001.
Take adequate time to complete your application. Use this time to reflect on the questions asked. Is Peace Corps
service right for you at this point in your life? If it is, thoughtfully completing this application will help you prepare for
the life-changing experience Peace Corps service can be.

Please read the Peace Corps Mission, three goals, and ten Core Expectations
below and then sign. These expectations frame your commitment to the Peace
Corps experience and to the application process you are now beginning
The mission of the Peace Corps is to promote world peace and friendship by:
•

Helping people of interested countries in meeting their need for trained men and women

•

Helping promote a better understanding of Americans on the part of peoples served

•

Helping promote a better understanding of other peoples on the part of Americans

Core Expectations For Volunteers
In working toward fulfilling the Peace Corps Mission, as a trainee and Volunteer, you are expected to:
1. Prepare your personal and professional life to make a commitment to serve abroad for a full
term of 27 months
2. Commit to improving the quality of life of the people with whom you live and work; and in
doing so, share your skills, adapt them and learn new skills as needed
3. Serve where Peace Corps asks you to go, under conditions of hardship if necessary, and with
the flexibility needed for effective service
4. Recognize that your successful and sustainable development work is based on the local trust
and confidence you build by living in, and respectfully integrating yourself into your host
community and culture
5. Recognize that you are responsible 24 hours a day, 7 days a week for your personal conduct
and professional performance
6. Engage with host country partners in a spirit of cooperation, mutual learning, and respect
7. Work within the rules and regulations of the Peace Corps and the local and national laws of the
country where you serve
8. Exercise judgment and personal responsibility to protect your health, safety and well-being
and that of others
9. Recognize that you will be perceived, in your host country and community, as a representative
of the people, cultures, values and traditions of the United States of America
10. Represent responsibly the people, cultures, values, and traditions of your host country and
community to people in the United States both during and following your service
I have read these expectations and understand that I am responsible for meeting
these expectations.

Signature
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PC-1502 (Rev. 06/2009)

Thank you for your interest in serving as a Peace Corps Volunteer. Should you become a Peace Corps Volunteer,
you will be undertaking an exciting and life-changing experience.
To be eligible for Peace Corps service, you must:
•

be a citizen of the United States;

•

be at least 18 years of age; and

•

meet the medical, legal, and security requirements.

Before beginning the full application process, please complete the following:

i. United States Citizenship:
Peace Corps Volunteers must be United States citizens or naturalized citizens.
Are you a U.S. Citizen? ❑ Yes

❑ No

If yes, give place of birth:
City _________________

State___________________Country__________________

Certificate of Naturalization number if you are a naturalized citizen:

___________________________________________________________________

] The Peace Corps cannot invite you to serve

until you are sworn-in as a naturalized citizen.

ii. Minimum Age:
Peace Corps Volunteers must be at least 18 years of age.
Birth Date: _______/_______/_________
Month

Day

Year

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PC-1502 (Rev. 06/2009)

iii. Health Requirements:
Because of circumstances in countries and communities where Volunteers serve, certain health conditions
cannot be accommodated during the 27 months of service. Other conditions may affect or limit where
you can be placed. At the end of the application is a section about your health status. If you have
concerns and would like to review the Medical Information for Applicants section prior to completing
the application, please visit:
www.peacecorps.gov/medical
The conditions listed in this section may disqualify you from serving or cause your application to be
deferred for a certain period of time.

iv. Peace Corps Drug and Alcohol Policy
Applicants with any drug-related charge/arrest or conviction in their legal history are not eligible to have
have their application considered for Peace Corps service until one year has passed from the date of
the arrest, or conviction, whichever is later.
Applicants charged with, or convicted of, public intoxication, DUI, DWI, or who receive a reduced charge
of, or conviction for, reckless driving from an initial charge of DUI or DWI, or who have a similar alcoholrelated offense in their legal history, are not eligible to have their application considered for Peace Corps
service until one year has passed from the date of the offense or conviction, whichever is later. This
includes arrests and citations.
Any arrest, citation, or other legal incident related to alcohol or illegal drugs that occur during the
application process, including up to the day of departure, will also disqualify an applicant. Any applicant
who is disqualified for the above reasons may reapply after one year.

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PC-1502 (Rev. 06/2009)

OMB # xxxxxx
Expiration Date: xx/xx/20xx

Peace Corps Volunteer Application
Contact and personal information relevant to serving as a Peace Corps Volunteer:
1. Name_ __________________________________________________________________________________________________
First

Middle (not initial)

2. Social Security Number _____–_____–______

Last

3. Gender

Female

❑

❑ Male

The Peace Corps asks for your Social Security number, or SSN, because the
Peace Corps Act (22 U.S.C. 2519) requires a background check on all Volunteers.
Your SSN is needed for this background check, so providing it is mandatory.
The Peace Corps will also use it to ensure that our records are accurate, and
for tax and other financial accounting purposes.

4. Availability:
A. The earliest date you can be available for Peace Corps service:

_______/_______/_________

B. The latest date you can be available for Peace Corps service:

_______/_______/_________

You will be considered for assignments
beginning after this date.
You must notify your recruiter if this date changes.

Month

Day

Year

5. Contact Information - Please provide the following address information:
A. Current address and contact information:

Name (First, Middle (not initial), Last)

Address (Number, Street, Apt. No.)

County

Home phone

Permanent e-mail address

City/State/ZIP
Country

Cellphone

Work phone (with extension)

B. Permanent address and contact information
(This should be a person/address where you can always be reached. This person should live in the United States.)

Contact Name (First, Middle (not initial), Last)

Relationship to you

Address (Number, Street, Apt. No.)

City/State/ZIP

County (California residents only)

Home phone

E-mail address

Country

Cellphone

Work phone (with extension)

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PC-1502 (Rev. 06/2009)

Each trainee or Volunteer is required to establish a “Home-of-Record” that the trainee or Volunteer determines to be
their permanent residence. The Home-of-Record is the only place to which travel will be authorized upon termination
of service. This can be changed by request if the Home-of-Record changes.
C. Home of Record and contact information

Contact Name (First, Middle (not initial), Last)

Relationship to you

Address (Number, Street, Apt. No.)

City/State/ZIP

County (California residents only)

Home phone

E-mail address

Cell phone

Work phone (with extension)

] Please notify your recruiter of any address changes.

6. Have you previously:
A. Submitted a Peace Corps application?

If yes, provide dates and location:

❑ Yes ❑ No _______________________________________________
Location

_
B. Participated in Peace Corps training?

______/_______/_________
Month

Day

Year

❑ Yes ❑ No _______________________________________________
Location

C. Served as a Peace Corps Volunteer?

______/_______/_________
Month

Day

Year

❑ Yes ❑ No _______________________________________________
Location

______/_______/_________
Month

D. Served as a PC Response Volunteer?

Day

Year

❑ Yes ❑ No _______________________________________________
Location

______/_______/_________
Month

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PC-1502 (Rev. 06/2009)

Day

Year

7. Marital Status (Check all that apply)
The Peace Corps follows state law to determine whether two individuals are married, except to the extent that state
law is inconsistent with the federal Defense of Marriage Act of 1996. Under that statute, for the purposes of federal
programs (e.g., the Peace Corps), marriages must be between a man and a woman. If your marriage is recognized under
the laws of your state of residence, and is in accordance with the Defense of Marriage Act, you and your spouse may
apply for Peace Corps service as a couple. Note that marriage certificates are required and should be submitted at the
point of application or shortly afterwards.
Both you and your spouse must apply and qualify for assignments in the same country.
If you are newly married, please be advised that all couples must be married in order to be nominated for an assignment,
and married for a minimum of 12 months before beginning Peace Corps service. Make sure that your availability date
is at least 12 months after your marriage date.
The Peace Corps cannot accommodate families with children or other dependents. If you and your spouse have
dependents, you must provide proof that their needs will be met during 27 months of Volunteer service.

D. ❑ Married—planning to serve without spouse

A. ❑ Single (never married)

Name of spouse:__________________________________

B. ❑ Planning to marry within one year

Expected date of marriage:_______/_______/_________ E. ❑ Widowed
Month

Day

Year

F. ❑ Divorced or legally separated

C. ❑ Married—planning to serve with spouse
Date of marriage: _______/_______/_________
Month

Day

Year

Documents
Each individual’s official Peace Corps documents, such as passport, host country work visa, and plane tickets must all be in
the same name. If your marriage plans involve a name change, note that legal procedures can take several weeks to provide
confirmations of name changes, couples must be married at least one year before their date of entering Peace Corps service.
Newlyweds must provide a marriage certificate and any name change confirmations at least six months prior to their listed
availability date (see Item 4 of this application).
If you are planning to serve with your spouse, submit your applications at the same time. Indicate name and Social Security
number of spouse or fiancé/fiancée below:
Name and Social Security number of spouse (fiancé/fiancée):
_ ___________________________________________________________________________________________________
First

Middle (not initial)

Last

_ ___________________________________________________________________________________________________
Social Security number

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PC-1502 (Rev. 06/2009)

List the name(s) of any/all former spouse(s) as well as the year(s) of divorce, separation, or death:

Name (First, Middle (not initial), Last)

Divorced

❑ Yes

_______/_______/_________

❑ No

Month

Separated

Death

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

Day

Year

Name (First, Middle (not initial), Last)

Divorced

❑ Yes

_______/_______/_________

❑ No

Month

Separated

Death

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

Day

Year

Name (First, Middle (not initial), Last)

Divorced

❑ Yes

_______/_______/_________

❑ No

Month

Separated

Death

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

❑ Yes

Day

Year

_______/_______/_________

❑ No

Month

Day

Year

If you are divorced, you must provide copies of all legal documents related to each divorce (including final divorce
decree, settlement agreements, spousal and child support agreements, etc.) in English, regardless of when or where,
including other countries, the divorce took place. Mail these directly to your regional recruitment office or scan and upload
to this application. If a former divorced spouse is deceased, it is not necessary to submit a final divorce decree.
If you are a married applicant planning to serve without your spouse, you will be required to provide additional

documentation.
Attach additional information if needed.

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PC-1502 (Rev. 06/2009)

8. Dependents
A. Are any persons partially or totally dependent upon you for support,

whether or not they are living with you?

❑

Yes

❑

B. List all children under age 18, whether or not they are dependent upon you for financial support.
Name of child

Address

Date of birth

Dependent?

________________________________________________________________________________________ _ ❑ Yes

❑

________________________________________________________________________________________ _ ❑ Yes

❑

________________________________________________________________________________________ _ ❑ Yes

❑

________________________________________________________________________________________ _ ❑ Yes

❑

C. List all dependents not listed above for whom you have support obligations.
Name of dependent

Address

Date of birth

______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
D. Serving as a Volunteer with dependents at home is often a challenge. Explain below how you will continue to meet
your support obligations while serving without salary as a Volunteer.
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________

] The Peace Corps does not place families or individuals accompanied
by dependent children. The Peace Corps requires a notarized letter
from the person assuming responsibility for your dependent(s).
This must be submitted to your regional recruiting office.

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PC-1502 (Rev. 06/2009)

9. Military Status

❑

A. Are you now a member of the ROTC, National Guard, or Reserves?

Yes

❑

If yes, how will you fulfill your obligation?______________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

❑

B. Have you ever served in the U.S. Armed Forces?

Yes

❑

If yes, complete the following:
Branch ______________________________________________

Serial/File number_ ________________________________

Highest rank held_ ____________________________________

Dates of service: from________/_______/_________
to

Month
Day
Year
________/_______/_________
Month
Day
Year

Type of discharge_ ____________________________________

C. If your discharge was other than honorable, explain the circumstances in detail below:

required to provide proof of IRR status.

] The Peace Corps cannot issue an invitation to serve until we have a
copy of your official discharge papers. Please plan accordingly.

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PC-1502 (Rev. 06/2009)

Attach additional information if needed.

10. Drug, Alcohol, and Legal Information
If you fail to disclose any required information r e g a rd i n g l e g a l , f i n a n c i a l , o r d r u g a n d

alcohol behavior, the Peace Corps may revoke your invitation to serve or disqualify you
from Peace Corps service. Any misleading, inaccurate, or incomplete information or
intentional omission may be cause for disqualification or termination. In addition, any
intentionally false statement may be subject to fines and/or imprisonment pursuant to
18 U.S.C. Section 1001.
A. Drug and Alcohol Information
The Peace Corps has a strict policy regarding
the use of drugs and alcohol. As a Peace Corps
Volunteer, you are responsible for your personal
conduct and professional performance 24/7 (Core
Expectation 5).You must exercise good judgment
and personal responsibility to protect your
health, safety, and well-being, and that of others
(Core Expectation 8). Please read the following
carefully — your personal conduct is critical to
your success as a Peace Corps Volunteer.

limited to: binge drinking; consuming more than 12
ounces of beer, six ounces of wine, or three ounces
of hard liquor in three hours, three times a week for
a period of three months; feeling that you should
cut down on your drinking; experiencing concern
from others who think that you drink too much;
feeling bad or guilty about your drinking; drinking
in the morning to steady your nerves or to get rid
of a hangover; or alcohol-related legal incidents.
1. Have you ever been arrested for, charged with, or convicted of any offense(s) related to alcohol or drugs?

❑

Drugs
A Volunteer or trainee found to be involved with drugs
in a manner not authorized for medical purposes,
in any way, in any country, will be administratively
separated immediately. Drug involvement by
Volunteers and trainees in any country could seriously
jeopardize the entire Peace Corps program, as well
as the safety and health of Volunteers and trainees.

Yes

❑

2. Have you ever been found guilty of an offense under section 404 of the Controlled Substance Act
(21 U.S.C. 844), while under the age of 21?

❑

Yes

❑

] The Peace Corps reserves the right to ask additional questions
about your drug and alcohol use.

Alcohol
In your host country and community you will be perceived as a representative of the people, culture, values, and traditions of the United States of America
(Core Expectation 9), and you are responsible for
your personal conduct and professional performance
(Core Expectation 5). The Peace Corps leaves decisions regarding the use of alcohol to the discretion
of the individual Volunteer or trainee. However, the
Peace Corps recognizes that excessive use of alcohol may compromise Volunteer or trainee safety
and security, lead to behavior that is a discredit to
the Peace Corps or the individual, or affect a Volunteer’s or trainee’s performance in an assignment.
The Peace Corps may deem an applicant
ineligible or unsuitable for Peace Corps service due
to problem drinking and/or abusive use of alcohol.
The terms “problem drinking,” “abusive use of
alcohol,” and their variants include, but are not

B. Legal Status and History
Report information regardless of whether the
record in your case has been sealed, expunged,
or otherwise stricken from the court record.
All Peace Corps invitees must undergo a National
Agency Check (NAC) background investigation to
help determine legal eligibility for service. The NAC
investigation will reveal all arrests regardless of disposition (i.e., suspended sentence, deferred judgment, dismissal, not guilty, reduced charge, mistaken
identity, or expungement), therefore it is required
that you disclose to the Peace Corps your official legal history and other experiences. The NAC form and
fingerprint charts will be provided at a later date.

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PC-1502 (Rev. 06/2009)

If you answered “yes” to any of the questions in sections A or B above, you must attach information sepa-

1. Have you ever been charged with or convicted of any
felony offense?
❑ Yes ❑ No

rately with: (1) your name, (2) type of offense/suit
(e.g., DUI, possession of marijuana, petty theft, suing
landlord), (3) complete explanation and detailed circumstances of each arrest, charge, suit, judgment, or
disciplinary action, (4) the relevant dates, (5) location
(city, state, country) of the occurrence, (6) current
status or disposition, and (7) any sentence, probation,
community service, fine, or other penalty imposed.

2. Are there currently any charges or probation pending
against you for any criminal offense?
❑ Yes ❑ No
3. Have you ever been subject to a court martial or other
disciplinary proceeding under the Uniform Code of Military Justice? (Include nonjudicial, captain’s mast, etc.)

❑

Yes

❑

4. Have you ever been arrested for, charged with, or convicted of any offense(s) not listed in questions 1 and
2 in the previous section and/or questions 1–3 above?
(Exclude traffic fines less than $200 unless the violation
was alcohol and/or drug related.)

❑

Yes

❑

Yes

❑

] Your

application will not be considered without this
information. It is your responsibility to inform the Peace
Corps throughout the application process of any changes
in your legal status, including arrests, charges, citations,
convictions, or legal eligibility. You may exclude parking
tickets and traffic fines less than $200.00.

5. Are you currently involved in a civil suit?

❑

If you answer “yes” to any questions in 13, provide additional details.

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PC-1502 (Rev. 06/2009)

11. Financial Obligations
Before you can serve in the Peace Corps, you must provide documentation establishing that you have made arrangements satisfactory to your creditor(s) to defer, pay, or otherwise fulfill all of your financial obligations. The Peace
Corps will run a credit report to verify your financial information.

❑

A. As of the date of this application, do you have any student loans?

Yes

❑

If yes, provide the following information. Attach additional information if necessary.
Type of Loan _____________________________ Amount $_______________
Principal deferrable?

❑

Yes

❑

Interest deferrable?

❑

Yes

❑

Type of Loan _____________________________ Amount $_______________
Principal deferrable?

❑

Yes

❑

Interest deferrable?

❑

Yes

Type of Loan _____________________________ Amount $_______________
Principal deferrable?

❑

Yes

❑

Interest deferrable?

❑

Yes

Call your student loan company about the possibility of deferment during Peace Corps service. If the loan is not
deferrable, please explain below how you will meet this loan responsibility.

B. As of the date of this application, do you have other financial obligations aside from student loans
(including, but not limited to, a mortgage, credit card debt, taxes, car loan, alimony, or child support)?

❑ Yes ❑

If yes, please provide the following information. Attach additional information if necessary.
Type of financial obligation ______________________________________________ Amount $__________________
Type of financial obligation ______________________________________________ Amount $__________________
Type of financial obligation ______________________________________________ Amount $__________________

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PC-1502 (Rev. 06/2009)

C. If you do have student loan(s) and/or financial obligation(s), will they be paid in full, deferred, or otherwise fulfilled prior
to your departure for Peace Corps training? ❑ Yes ❑ No
If you answered “No,” describe your plans to satisfy the obligation(s) while serving in the Peace Corps. If someone is
assuming payment of your financial obligation(s), the Peace Corps requires the original version of a notarized letter from the
person affirming their commitment to make those payments.

]

If you have any questions about these legal and financial issues that your recruiter cannot answer, call the
Peace Corps Legal Eligibility Office at 800.424.8580, select option 2 to reach a headquarters office, then
dial extension 1845 for assistance.

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PC-1502 (Rev. 06/2009)

12. Intelligence Activities and Organizations
Depending upon the nature of an applicant’s involvement in, or relationship to, intelligence activities or agencies, the duration of disqualification may
range from a permanent disqualification, disqualification up to 10 years or disqualification for 10 years
or more. Applicants are also advised that service as a
Peace Corps Volunteer may result in disqualification
from employment with intelligence agencies of the
U.S. government for periods following service as a
Volunteer.
In some cases, employment or association with
certain intelligence activities or agencies will result
in the Peace Corps instructing you to contact those
agencies who will coordinate with the Peace Corps,
as necessary and appropriate, to assist Peace Corps
in rendering a final decision on your application.

It has been the Peace Corps’ policy since its
founding in 1961 to exclude from Peace Corps Volunteer service and Peace Corps employment, in accordance with Peace Corps Manual Section 611, any
persons who have engaged in intelligence activity or
related work or who have been employed by or connected with an intelligence agency. This policy has
been reaffirmed by each successive administration.
The policy is founded on the premise that it is
crucial to the Peace Corps in carrying out its mission
that there be a complete and total separation of the
Peace Corps from the intelligence activities of the
United States government, both in reality and appearance. Any semblance of a connection between
the Peace Corps and the intelligence community
would seriously compromise the ability of the Peace
Corps to develop and maintain the trust and confidence of the people of the host countries. Serious
doubts about an applicant’s connection with intelligence activities are to be resolved in favor of exclusion.
“Intelligence activity” includes any activities or
specialized training involving or related to the clandestine collection of information, or the analysis or
dissemination of such information, intended for use
by the United States government in formulating or
implementing political or military policy in regard to
other countries. The term “intelligence activity” includes any involvement in covert actions designed to
influence events in foreign countries.
Persons currently or formerly employed by the
Central Intelligence Agency shall be permanently
ineligible for Peace Corps Volunteer service. Employment with other intelligence agencies may also
be disqualifying. In addition, applicants may be disqualified for service because their background or history discloses a substantial connection with an intelligence activity or related work other than through
employment. Even family relationships to an employee of an intelligence agency maybe considered a
disqualifying connection.

Based upon the preceding, please answer the following
questions:
A. Have you or a family member ever been employed by
or connected with an intelligence agency, or engaged
in intelligence activity or related work?

❑

Yes

❑

B. Are you currently applying for employment or an
internship with any intelligence agency or other
organization associated with intelligence activities?

❑

Yes

❑

If yes, you will be required to withdraw all applications for employment with intelligence agencies
after accepting an invitation to serve in the Peace
Corps and to provide the Peace Corps with a copy
of the letter to each agency requesting the withdrawal of your application.

You have now provided us with the basic information needed. The following questions are your opportunity to
provide the Peace Corps with additional information that will help us determine if your interests, skills, experience,
and educational background are a match for Peace Corps service. Information about your education, work
experience, volunteerism and other activities are important to assessing skills and geographic priorities.

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PC-1502 (Rev. 06/2009)

13. Postsecondary Education

Name of school

City, State

From (Mo/Yr)

to (Mo/Yr)

From (Mo/Yr)

to (Mo/Yr)

Major

Second Major

Minor

Second Minor

Type of degree, diploma, or certificate

Date received or expected

GPA

Name of school

City, State

From (Mo/Yr)

to (Mo/Yr)

From (Mo/Yr)

to (Mo/Yr)

Major

Second Major

Minor

Type of degree, diploma, or certificate

Date received or expected

GPA

You must mail or email a copy of transcripts, from all post-secondary schools attended within the past 10 years, directly
to your regional recruitment office (an unofficial copy is acceptable as long as your name is listed). List all schools attended, regardless of attendance dates.
The Master’s International program offers a unique opportunity to combine Peace Corps service with a master’s degree

program. Prospective students apply separately to Peace Corps and to a participating graduate school. Once accepted
by both, students will study on campus, usually for one year, and then spend the next two years earning academic
credit while working overseas in a related Peace Corps project. Most schools provide students in this program with
opportunities for research or teaching assistantships, scholarships while on campus, or tuition waivers for credits are
earned while serving in the Peace Corps.
Are you applying to the Master’s International program?

❑

Yes

❑

If yes, please indicate which school and program below
____________________________________________________________________________________________________
Name of School

_ ___________________________________________________________________________________________________
Program
_ ___________________________________________________________________________________________________
Name of School

_ ___________________________________________________________________________________________________
Program

] Please note that you must be accepted by a Master’s International school before you can be nominated for Peace Corps service.
For information about Masters International: www.peacecorps.gov/gradschool
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PC-1502 (Rev. 06/2009)

14. Language Skills
Many assignments require previous language study. Select the answer that most closely describes your formal and/or

informal language experience. You will have the opportunity to discuss your language skills in more detail during the
interview process. If you have been out of school less than 8 years, please complete the following course information:
Formal Language Acquisition (e.g., highest level completed, # years studied, high school, college and/or graduate

school.)

(Please explain and give dates)

From Mo/Yr to Mo/Yr

Spanish
French
Language
Language

Informal Language Acquisition (e.g., study abroad, field experience, spoken at home, other accredited organization, etc.)
(Please explain and give dates)

From Mo/Yr to Mo/Yr

Spanish
French
Language
Language

Language Skill Ranking - Please rank your skills in the languages with which you are familiar. Guidelines for your rankings
are described below.

Language

Oral Proficiency

Written Proficiency

Listening Proficiency

Language

Oral Proficiency

Written Proficiency

Listening Proficiency

17
PC-1502 (Rev. 06/2009)

Explanation of Language Skills
Bilingual Language Skills
•

Oral Explanation - Speaking proficiency equivalent to that of an educated native speaker.

•

Written Explanation - Able to handle formal translations from and into the language.

•

Listening Explanation - Understand a range of speech styles for personal, social, and professional
needs tailored to different audiences. Process language from within the cultural framework and
is sensitive to social references. Comprehend plays, screen productions, editorials, academic
debates, public policy statements, literary reading, jokes, and most slang.

Professional Language Skills
•

Oral Explanation - Able to use the language accurately in all settings.

•

Written Explanation - Able to handle informal translations from and into the language.

•

Listening Explanation - Understand the main ideas of speech in a standard dialect, including
technical discussion in a field of specialization. Make inferences within the cultural framework of
the targeted language. Follow extended discussions in lectures, speeches, and reports.

Limited Language Skills
•

Oral Explanation - Able to handle most social situations, including introductions and casual
conversations.

•

Written Explanation - Able to write elementary documents, such as completing limited work
requirements that require no specialized knowledge.

•

Listening Explanation - Understand sentences in context, especially words referring to basic
personal features, needs, and activities. Understand face-to-face conversations, short telephone
calls, and media announcements.

Basic Language Skills
•

Oral Explanation - Able to ask and answer questions on very familiar topics.

•

Written Explanation - Able to write simple questions and statements.

•

Listening Explanation - Understand short phrases and frequent commands. Require long pauses
for assimilation.

18
PC-1502 (Rev. 06/2009)

15. Licenses/Certificates

Are you, will you be, or have you been a state-certified teacher?
State

❑

Subject

Yes

❑

Grade Level

_______________________________________________________________________________________________________
List other job-related current or former licenses or certificates such as nursing or skilled trades rankings (including journeyman
status).
Expiration
Date

License or Certificate

State or Other
Licensing Agency

1.
2.
3.
4.

] After you submit your application, you must mail a photocopy or email an electronic copy of each
current license/certificate directly to your regional recruiting office.

16. Employment History
Your Peace Corps service is a commitment to improving the quality of life of the people with whom you live and
work and, in doing so, you will share your skills, adapt them, and learn new skills as needed (Core Expectation 2).
Please complete this section and attach a copy of a current resume.
Starting with your most recent experience, please list at least 10 years of your employment history. Include any selfemployment and full- or part-time paid employment. You may list additional employment history if you believe it is
relevant to Peace Corps service. This section should be filled out completely. Stating “see resume” is not acceptable.
Phone number, email address, and request to contact are only necessary for current and most recent former employment.
Current employer name:

Previous employer name:

City/State

From (Mo/Yr)

to (Mo/Yr)

From (Mo/Yr)

Job title

Duties/Achievements

Hours per week

Name of supervisor

Phone number

Email address

May we contact your current employer?

❑

Yes

❑

to (Mo/Yr)

May we contact your former employer?

Reason for leaving

❑

Yes

❑

Reason for leaving

19
PC-1502 (Rev. 06/2009)

Previous employer

City/State

From (Mo/Yr)

to (Mo/Yr)

From (Mo/Yr)

to (Mo/Yr)

Job title

Duties/Achievements

Hours per week

Name of supervisor

Phone number

Email address

May we contact your former employer?

❑

Yes

❑

May we contact your former employer?

Reason for leaving

Yes

❑

Yes

❑

Reason for leaving

Previous employer

City/State

From (Mo/Yr)

❑

to (Mo/Yr)

From (Mo/Yr)

to (Mo/Yr)

Job title

Duties/Achievements

Hours per week

Name of supervisor

Phone number

Email address

May we contact your former employer?

❑

Yes

❑

May we contact your former employer?

Reason for leaving

17. Time Gaps

Give specific dates and activities for each period of time greater than three months not otherwise accounted for by
employment, school, military, etc.

Attach additional information if needed.
20
PC-1502 (Rev. 06/2009)

18. Community/Volunteer Activities

Peace Corps assignments require applicants to have leadership ability, creativity, initiative, flexibility, and a willingness
to work with others. You will engage with host country partners in a spirit of cooperation, mutual learning and respect
(Core Expectation 6), and respectfully integrate yourself into your host community and culture (Core Expectation 4).
Please describe your community, volunteer, or organizational experience that demonstrates the following skills or abilities:
• Initiating or carrying out activities

• Motivating others to get and stay involved

• Planning activities involving others

• Leading, supervising, or managing others

• Organizing others to participate in
activities or to perform tasks
In addition, many applicants have gained technical or subject skills relevant to Peace Corps assignments through
community and volunteer activities. You may have gained other skills not normally thought of as relevant skills to
the Peace Corps. Thus, it is important to be as inclusive as possible in describing your activities. List your most
recent activity first. Do not include experiences already listed in your employment history.

Organization Name

Position held

From (Mo/Yr)

to (Mo/Yr)

Hours per week

Name of supervisor

May we contact your supervisor?

❑

Yes

❑

May we contact your supervisor?

Phone number

Email address

Duties/Achievements

Organization Name

Position held

From (Mo/Yr)

to (Mo/Yr)

Hours per week

Name of supervisor

May we contact your supervisor?

❑

Yes

❑

May we contact your supervisor?

Phone number

Email address

Duties/Achievements

to (Mo/Yr)

❑

Yes

❑

to (Mo/Yr)

❑

Yes

Attach additional information about your community or volunteer activities if needed.
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21
PC-1502 (Rev. 06/2009)

19.

Practical Experience
As a Peace Corps Volunteer, you commit to improving the quality of life of the people with whom you live and work, and
in doing so, you share your skills, adapt them, and learn new skills as needed (Core Expectation 2). The experience
you have gained from hobbies, volunteer activities, and part-time or summer jobs may help you qualify for Peace Corps
service. A number of skill areas and related activites are listed below. In space provided, please describe significant
experiences you have had. If you described an experience elsewhere in the application, it is not necessary to repeat the
information here.
Agriculture and Environment
Beekeeping
Environmental Education/Conservation
Farming (after age 13)
Fisheries
4-H/FFA/FHA
Forestry/Greenhouse/Nursery
Parks/Wildlife
Vegetable Gardening
Agricultural Engineering
Environmental Engineering
Food Security

Business
Accounting/Bookkeeping
Business Management
Business Training
Cooperatives/Credit Unions
Fundraising
Marketing
Volunteering with or working for nonprofits

Education/Teaching
Adult Education
Business Education
English/ESL/TEFL Tutoring
Art/Drama
Library Experience
Sports/Physical Education

Health and Social Services
Health Outreach
Home Economics
Social Work/Counseling
Youth Work/Coaching/Sports
Long-term Assisted Care
HIV/AIDS Education
Hospice

Specific activity:

Information and Communication
Technology
Computer Science
Computer Literacy
Radio
TV
Media Technologies

Skilled Trades
Auto/Diesel Mechanics
Construction
Electricity
Masonry
Metalworking
Plumbing
Vocational Education
Woodworking

From (Mo/Yr)

to (Mo/Yr)

Hours per week

From (Mo/Yr)

to (Mo/Yr)

Hours per week

From (Mo/Yr)

to (Mo/Yr)

Hours per week

From (Mo/Yr)

to (Mo/Yr)

Hours per week

Description of experience:

Specific activity:
Description of experience:

22
PC-1502 (Rev. 06/2009)

20. Regional Interests
How and where the Peace Corps assigns Volunteers is based largely on matching the educational and work experience of applicants with the kinds of projects for which countries have requested assistance. As a result, the Peace
Corps cannot guarantee placement in any specific region or country. Our priority is to place an applicant where his
or her skills are most needed, which may be under conditions of hardship (Core Expectation 3). Applicants who are
flexible about where they will go and what they will do are, therefore, more competitive.
The Peace Corps mission supports the needs of communities and honors the requests of host countries in providing
Volunteers where they are needed most. We review with you your potential skill areas and where they are needed,
your health status and where noted concerns can best be accommodated, and your availability for service and when
groups of trainees are beginning service. Your regional interest, if any, is also a consideration when the other conditions are met.

A. Which best describes your interest in volunteering with the Peace Corps?

I am willing to go anywhere and do anything as needed.

I wish to go to a particular geographic region, but will do anything needed.

(Select one)

B. Please indicate your geographic interests:

No preference

Eastern/Central Europe

Asia

North Africa/Middle East

Central Asia

Pacific Islands

Caribbean

Sub-Saharan Africa

Central/South America

Briefly explain any preferences:

The Peace Corps does not place Volunteers in countries where you may have family or other potential conflicts of
interest. In what countries do you have family members?

23
PC-1502 (Rev. 06/2009)

21. Essay Questions
Thank you for the time you have taken to thoughtfully and accurately answer the previous questions. The following
essay questions will provide the Peace Corps with additional information and insights that will be used to assess
your suitability for Peace Corps service. If you are invited to serve as a Peace Corps Volunteer, your responses will
be shared with staff in your country of service. (Minimum of 250 words)
A. Peace Corps service presents major physical, emotional, and intellectual challenges. You have provided
information on how you qualify for Peace Corps service elsewhere in the application. In the space below,
please provide a statement (between 250-500 words) that includes:
• Your reasons for wanting to serve as a Peace Corps Volunteer; and
• How these reasons are related to your past experiences and life goals.

• How you expect to satisfy the Peace Corps 10 Core Expectations (please be specific about which
expectations you expect to find most challenging and how you plan to overcome these challenges).

24
PC-1502 (Rev. 06/2009)

B. Your success as a Peace Corps Volunteer is based on the trust and confidence you build by living in, and
respectfully integrating yourself into, your host community and culture (Core Expectation 4). Describe an
experience you have had in living or working in a social or cultural environment different from your own. What
specific challenges did you face concerning trust, confidence, and/or integration? What did you learn from this
experience that you will bring with you to your Peace Corps service?

Sign and date the application on the next page.
25

➧

PC-1502 (Rev. 06/2009)

22. Certification
I CERTIFY that all of the statements made on all pages of this application, including attachments, are true, correct,
and complete to the best of my knowledge and are made in good faith. I understand that any misleading, inaccurate,
or incomplete information may be cause for disqualification or termination from Peace Corps service. In addition, any
intentionally false statement or intended omission may be subject to fines and/or imprisonment pursuant to 18 U.S.C.
§ 1001.
I also understand it is my responsibility throughout the application process to inform the Peace Corps of any changes
to the information provided here.

Signature

Date

Request for Racial and Ethnic Data

This information is voluntary. Your response will not affect consideration of your application. By providing this information, you will assist in assuring that the Peace Corps is administered in a nondiscriminatory manner and reflects
the diversity of the United States. The information requested in this section is covered by the Privacy Act Notice.

Please check one or more of the classifications in each of the two sections below.

Ethnicity

❑

Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. The term, “Spanish” origin can be used in addition to “Hispanic” or
“Latino”)

❑

Not Hispanic or Latino

Race
❑

American Indian or Alaska Native (a person having origins in any of the original peoples of North and South
America [including Central], and who maintains tribal affiliation or community attachment)

❑

Asian (a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam)

❑

Black or African American (a person having origins in any of the black racial groups of Africa. Terms such
as “Haitian” or “Negro” can be used in addition to “Black” or “African American”)

❑

Native Hawaiian or Other Pacific Islander (a person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands)

❑

White (a person having origins in any of the original peoples of Europe, the Middle East, or North Africa)

26
PC-1502 (Rev. 06/2009)

Privacy Act and Paperwork Reduction Notice

The Peace Corps, an agency of the federal government, is required by the Privacy Act of 1974 (5 U.S.C. 552a)
to advise you of the following information regarding this application. The Privacy Act addresses the federal
government’s use of certain personal information in agency files.

A. This application is authorized by the Peace Corps
Act (22 U.S.C. 2501 et seq.).

• In the case of United Nations Volunteers, to appropriate U.N. officials;

B. The principal purpose for which the information provided
will be used is to evaluate your suitability and qualifications to serve in a Peace Corps full-time Volunteer
program.

• To law enforcement agencies as appropriate;

C. Information in this application may routinely be disclosed
as follows:
• To Peace Corps staff and contractors who have
a need for the information in performance of their
duties;
• To host country officials for the purposes of obtaining visas and determining program placement;
• To your family or next-of-kin so that you may be
located in case of emergency;

• As necessary to obtain information relevant to a
security clearance;
• To federal agencies having a need to verify Volunteer
eligibility for federal employment;
• To the U.S. Office of Management and Budget in
connection with private relief legislation;
• To the Department of Justice and others for litigation purposes;
• To the National Archives and Records Administration for records retention and records management
inspections;

• In compelling circumstances affecting your health
and safety;

• To the U.S. Office of Personnel Management in
connection with their evaluation and oversight of
federal personnel management;

• To Congressional offices in response to an inquiry made at your request, or to Congress as
requested;

• To the Bureau of the Census for census purposes;

• To a U.S. ambassador or designee in a country
where the Peace Corps serves when the information is needed to perform an official responsibility,
to respond to official inquiries and deal with incountry situations that are within the scope of the
ambassador’s responsibility;
• As required under the Freedom of Information
Act;
• To a court or other judicial body as appropriate;
• To the Department of Treasury and other federal
agencies for use in connection with support payments, tax matters and Social Security;
• To verify active or former Volunteer service;

• Without personal identifiers, for statistical purposes;
• To the comptroller general in the performance of the
duties of the Government Accountability Office.
D. The completion of this form is voluntary. However, the
failure to do so will result in the Peace Corps being unable
to assess your qualifications and result in non-selection for
the Volunteer program for which you have applied.
E. The Peace Corps estimates that it will take eight hours to
complete this form. Send comments about this form to:
Peace Corps
Paul D. Coverdell Peace Corps Headquarters
1111 20th Street NW
Washington, DC 20526

The Peace Corps may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number 0420-0005.

IMPORTANT: The Peace Corps does not discriminate based on race, color, national origin, religion, age, sex,
handicap, political affiliation,or sexual orientation. Anyone who feels he or she has been discriminated against
should contact the Peace Corps American Diversity Office, 1111 20th Street, NW, Washington, D.C. 20526

OMB control number: 0420-0005 Continuous use form.

If you live in…

Mail your completed form to this Peace Corps office:

Alabama, Florida, Georgia, Mississippi,
Puerto Rico, South Carolina,Tennesee, or
the U.S. Virgin islands

Atlanta Regional Recruitment Office
100 Alabama Street, Building 1924, Suite 2R70
Atlanta, GA 30303

Fax 404.562.3455
Questions? 404.562.3456
[email protected]

Massachusetts, Maine, New Hampshire,
Rhode Island, or Vermont

Boston Regional Recruitment Office
Tip O’Neill Federal Building
10 Causeway Street, Suite 559
Boston, MA 02222

Fax 617.565.5539
Questions? 617.565.5555
[email protected]

Illinois, Indiana, Iowa, Kentucky, Minnesota,
Michigan, Missouri, North Dakota, Ohio,
South Dakota, or Wisconsin

Chicago Regional Recruitment Office
55 West Monroe Street, Suite 450
Chicago, IL 60603

Fax 312.353.4192
Questions? 312.353.4990
[email protected]

Arkansas, Colorado, Kansas, Louisiana,
Nebraska, New Mexico, Oklahoma, Texas
Utah, or Wyoming

Dallas Regional Recruitment Office
1100 Commerce Street, Suite 427
Dallas, TX 75242

Fax 214.253.5401
Questions? 214.253.5400
[email protected]

Arizona or Southern California

Los Angeles Regional Recruitment Office
2361 Rosecrans Avenue, Suite 155
El Segundo, CA 90245

Fax 310.356.1125
Questions? 310.356.1100
[email protected]

Connecticut, New Jersey, New York,
or Pennsylvania

New York Regional Recruitment Office
201 Varick Street, Suite 1025
New York, NY 10014

Fax 212.352.5441
Questions? 212.352.5440
[email protected]

Northern California, Hawaii,
or Nevada

San Francisco Regional Recruitment Office
1301 Clay Street, Suite 620N
Oakland, CA 94612

Fax 510.452.8441
Questions? 510.452.8444
[email protected]

Alaska, Idaho, Montana, Oregon,
or Washington

Seattle Regional Recruitment Office
1601 Fifth Avenue, Suite 605
Seattle, WA 98101

Fax 206.553.2343
Questions? 206.553.5490
[email protected]

Washington DC, Delaware, Maryland,
North Carolina, Virginia, or West Virginia

Washington, D.C. Regional Recruitment Office
1525 Wilson Boulevard, Suite 100
Arlington, VA 22209

Fax 202.692.1041
Questions? 202.692.1040
[email protected]

800.424.8580 | www.peacecorps.gov

File Type	application/pdf
File Title	PCVApp09layout_090309.indd
File Modified	2009-09-03
File Created	2009-09-03