Form 0490-0533 Peace Corps Crisis Corps Volunteer Application Form

Apply.

Please complete this application and return along
with a copy of your résumé and Description of
Service (if available) to:

Peace Corps
Crisis Corps
Paul D. Coverdell Peace Corps Headquarters
1111 20th Street NW
Washington, DC 20526
Fax: 202.692.2251 E-mail: [email protected]

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crisis corps ap p li cati o n

Technical Skills

Name_ __________________________________________________________________________________________

Please check only those skills in which you
have at least one year’s work experience.

Address _________________________________________________________________________________________
City___________________________________________________________ State__________ Zip________________
Phone (home)_ _____________________________________ (work)_________________________________________
Fax_ ______________________________________________ Cell___________________________________________
E-mail___________________________________________________________________________________________

Administration/
Management

Agriculture

HIV/AIDS Activities

Construction

Water and Sanitation

Other (specify) _________________________________________

Environment

Health

Agroforestry
Business/Economic
Development
Education

Mental Health
Organizational/
NGO Development
Youth Development

Country of Service _ _______________________________________________________________________________
Dates of Service* _ __________________________________ to_____________________________________________

(month/year)
(month/year)

Additional Overseas Work Experience
Please check those regions in which you
have at least one year’s work experience.

Describe your Peace Corps Volunteer Assignment
(e.g., Education — taught secondary school science; Water and Sanitation — built latrines)

Africa
Asia
Caribbean

Inter-America
Mediterranean
Pacific

Europe

Availability for Crisis Corps Assignments
Section One: Length of service

Language Skills

Specify each language with level of spoken skill: fluent, conversational, basic.

Three to four months
maximum

Five to six months
maximum

Section Two: Availability

Degrees, Professional Licenses, and Certifications (please specify)

Available throughout the year
Available from______________________to_______________________

mo/day/yr

mo/day/yr

Signature____________________________________________________

How did you learn about the Crisis Corps? (please specify)

COS conference

Website

Hotline

Peace Corps mailing

Other__________________

Date_ ____________________________

* Do not include training

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