Form PC-DP.969.5 Correspondence Match Educator Enrollment Form

Correspondence Match Educator Enrollment Form

Correspondence with a Peace Corps Volunteer can enhance your students' learning in almost any subject area. Peace Corps Volunteers serve in every region of the world, working at the grass-roots level. Their stories, projects, and experiences can provide U.S. students with in-depth, firsthand perspectives of global cultures - views not usually accessible through textbooks, films, or other media.

To take part in this unique opportunity, please fill out the form below. Feel free to share this program with your colleagues.

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*Teacher:

* School:

* Address 1:

Address 2:

* City:

* State:

* ZIP Code:

* Work phone:

Alt. phone:

* Email:

* Grade level:

* Number of students:

Special Requests:

Although we will do our best to honor your requests, limiting your preferences will expedite the process.

Name of Volunteer (if known)

Volunteer Home

No preference

Country of service:

No preference

Central America

Caribbean

South America

Pacific Islands

Asia

Eastern Europe and Central Asia

North Africa/Middle East

Sub-Saharan Africa

Languages spoken:

No preference

French

Spanish

Areas of work

No preference

Education

Health

Community Economic Development

Youth in Development

Agriculture

Environment

How did you learn about this program?

OMB Control Number 0420-0540

Expiration Date: X/XX/2014

Privacy Act Notice: This information is being collected pursuant to 22 U.S.C. 2501(a). This information will be used in processing your enrollment in the Correspondence Match program. Disclosure of this information is voluntary. Failure to provide sufficient information may preclude your consideration for Correspondence Match. This information may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and the Peace Corps' published Routine Uses, summarized in Peace Corps' System of Records.

Paperwork Reduction Act Burden Statement: Public reporting burden for this information collection is estimated to average 10 minutes. This includes the time for reviewing instructions and completing the information. This is voluntary information collection. An agency may not conduct or sponsor, and persons are not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: the FOIA Officer, Peace Corps, 1111 20^th Street NW, 2^nd Floor, Washington, D.C. 20526.

PC-DP.969.5 (Rev. 04/2014)

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