First name
Last name
Email
Mobile
1.
Date of Birth
2.
With what gender do you identify?
Please select
Male
Female
Non-binary and/or non-conforming
I'd rather not say
3.
Occupation/Area of study
4.
Please outline any extra-curricular activities that you currently pursue.
5.
Have you been involved in any community work? If so, please describe.
6.
Have you worked with children/young people before? If so, please describe.
7.
Have you worked with First Nations communities in the past? If so, please describe.
8.
Derech Eretz requires participants to devise and implement school holiday activities for children of various ages. Please briefly outline an activity you think could be executed quickly and easily with approximately 15 children between the ages of 5 and 13. Why did you choose this activity?
9.
Please outline the skills and attributes you believe make you suitable for participating in Derech Eretz.
10.
An aim of Derech Eretz is to develop a long term friendship with the youth and other community members during and after the trip. Do you think you will be able to continue to make ongoing efforts to building this friendship following the trip? For example, attending future trips.
11.
Please list the names, contact details (mobile and email) and role/ organisation of two references. If you have previously worked/volunteered with children, please use as a referee.