To secure a spot on a project team please fill out and send in your application as soon as possible. Priority is given to early applicants. A $500 non-refundable deposit is required to be placed on a team. This deposit will go toward your team fee. The balance will be due within 60 days of your team departure. If you are not placed on a team the deposit will be refunded.

The team fee is $450 per week for 3-4 week teams and an additional $200 per week for teams lasting longer than 4 weeks. The length of your stay will be determined by your project (please refer to "TEAM PROJECTS FOR 2013" page for team lengths). This fee does not include your travel expenses. Each volunteer is responsible for travel to and from Mozambique. (Please refer
to "FAQ" page further information)

TEAM PREFERENCE

Designate below the project you would like to be involved with. A list of projects can be found on the TEAM PROJECTS FOR 2013 page. Also, describe in detail how you will contribute to this project and explain skills and experience that will help you with its completion.

If you desire to develop a project that is not listed, please propose an alternate project below and provide a detailed description of your project and how you will complete it. If you are proposing your own project, please indicate the number of assistants that you would like to have on your team to help with this project.

PERSONAL INFORMATION

Gender  Male  Female

First Name

Last Name

Preferred Name 

Date of Birth (dd-mm-yyyy) 

Cell Phone Number 

Home Phone Number 

Email Address

Current Address 

City 

State 

Zip Code 

Permanent Address 

City 

State

Zip Code 

How did you learn about Care for Life?

Describe how working in Mozambique with Care for Life will help you with your career or
educational goals. Tell us if you will be using this experience as in internship.

BACKGROUND INFORMATION

List your education and previous volunteer experience.

PERSONAL REFERENCES

References should not include relatives. Church leaders, teachers, and employers are preferred.

REFERENCE #1

Name

Phone 

Email 

Address 

REFERENCE #2

Name 

Phone 

Email 

Address 

REFERENCE #3

Name 

Phone 

Email 

Address 

MEDICAL HISTORY (MEDICAL INFORMATION DOES NOT HAVE TO BE FILLED OUT IF VOLUNTEERING IN THE US)

Blood Type

Please list/describe any illnesses, injuries, or operations you have had.

Have you ever suffered from any psychiatric or psychological problem,
including anxiety or depression. If so, describe list below.

Please list any allergies.

Have you ever been convicted of a crime? If so, please explain.

EMERGENCY CONTACT INFORMATION

Name

Phone

Cell Phone 

Email 

Address 

Relationship 

*The above information is truthful and complete.
PRINT NAME 

BEN HARPER SCHOLARSHIP APPLICATION

Fill out this section ONLY if you are applying for the Ben Harper Scholarship. Click here for more information about the Ben Harper Scholarship.

1. Please tell us about your family background.

Your occupation/If student – Parents’ occupation 

Marital status 

Number of children/ If student – number of siblings

2. Please tell us why you are interested in serving in Africa. Be as specific as you can be.

3. Please tell us what kinds of service you have been involved with in the past. Be as specific as
you can be.
[service-experience]