Form NRCS-PER-002 Volunteer Interest and Placement Summary

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NRCS-PER-002
Exp. 07/31/2012
Form Approved – OMB No. 0578-0024

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)

Yes

No

B. 1. Where?
B. 2. What Kind?
C. Education (Check the highest level of education completed)
Grade 1

2

3

4

College: 1

2

3

4

5

6

7

8

9

10

11

12

C. 1. Degree: ___________________________________________________

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

Public Speaking

Clerical

Computer

Office

E. 1. Other (please specify): ______________________

F. What is Your Area of Availability?
(Check one box)
City
County
State

Photography

Writing

F. 1. Date of Availability: _____________________________________
F. 2. How Much Time Can You Give? ______ Hours Per: ________

F. 3. Why Do You Want To Work for NRCS?
G. Are You A United States Citizen? (Check one Box)

Yes

No

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) _____________________________________________________________________________
International Volunteers must complete the reverse side of this form.

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.
Public Burden Statement
In accordance with the Privacy Act of 1974 (5 USC 552a) and 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 or 3 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 of information.

NRCS-PER-002
Exp. 07/31/2012

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 that you contact 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 your
Embassy asks for a letter of invitation, the USDA-NRCS is prohibited from issuing letters of invitation. If you have any
questions regarding obtaining a visa and planning a visit with NRCS, please contact the USDA-NRCS International
Programs Division at (301)504-2271.