Application Form
YOUTH for DEVELOPMENT and GLOBAL XCHANGE
A collaboration between PRAVAH AND VOLUNTARY SERVICE OVERSEAS (VSO).
Please make sure you have read through the program details before filling this form. For any queries or
more information visit younginfluencers.com or contact Lokasish at 011- 26440619/ 26213918/ 26291354.
and/or mail us at lokasish.saha@pravah.org or smile@younginfluencers.com
Please complete and return this form to PRAVAH, C-24 B, 2nd floor, Kalkaji, New Delhi-110019 or email
the applications to lokasish.saha@pravah.org or smile@younginfluencers.com
.
Eligibility Criteria:
Age – 18 to 27years
Nationality - Indian
Language – Spoken knowledge of English and/or Hindi
PERSONAL DETAILS:
Name: ________________________________________________________________
Current Address:_________________________________________________________
Permanent Address:______________________________________________________
Tel No(s). __________________________ E- mail:____________________________
Date of Birth (DD/MM/YY)_____ ____________ Age_________
Nationality:_______________ Gender: Male Female
Do you have a passport (please tick): Yes No Applied for
If yes, then passport valid till:____________
How did you hear of this programme?________________________________________
EDUCATION QUALIFICATION:
Please give details of your educational background (beginning from the most recent)
Course Year Institution /school University/board
From To
LANGUAGE SKILLS (please tick level of proficiency):
Languages Speak Read Write
Hindi
English
Any other (specify)-
Any other (specify)-
WORK EXPERIENCE (paid and voluntary):
Please give details of your work experience (starting from the most recent):
Organisation:__________________________________________________________________
Period (Month and Year) : From_______________________ To _______________________
Job Description: _______________________________________________________________
____________________________________________________________________________
Organisation: _________________________________________________________________
Period (Month and Year): From ______________________ To _________________________
Job Description: ______________________________________________________________
____________________________________________________________________________
Organisation: _________________________________________________________________
Period (Month and Year): From _______________________ To _________________________
Job Description: _______________________________________________________________
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ADDITIONAL INFORMATION
Please answer the following questions:
1. Which of the two programmes would you like to apply for and why? How do you think this will
impact your future goals?
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2. Tell us about a situation in which you adapted to a different living environment. What were
some of the challenges you faced, and how did you handle them?
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3. Describe an initiative that you took, professional or academic, and how you grew as a
person because of it.
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REFERENCE
Please give two referees with names and addresses. The referees should be people you have
worked/working with or studied/studying under.
First Referee Second Referee
Full Name:__________________________ Full Name:__________________________
Address:____________________________ Address:____________________________
___________________________________ ___________________________________
___________________________________ ___________________________________
Tel No. :____________________________ Tel No. :____________________________
Email: __________________________ Email: __________________________
Occupation:______________________ Occupation:______________________
________________________________ ________________________________
Relationship:______________________ Relationship:______________________
________________________________ ________________________________
MEDICAL INFORMATION
If you are accepted for this Program, you will need to have a full medical examination. There are some
medical conditions that we are unable to support while participants are on the programme.
Have you ever had any major illness Do you have any allergies/allergic
(physical/ psychological) or accidents or reactions to vaccinations?
operations?
Yes No
Yes No
If yes then please give details:
If yes then please give details:
___________________________________
___________________________________
___________________________________
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Declaration
I hereby declare that all the above entries made by me are true to the best of my knowledge.
I understand that signing this form does not entitle me to be part of this program.
Sign Date
As an equal opportunity organisation, we encourage applications from women, disabled people and
people who have personal experience of HIV
THANK YOU FOR FILLING THIS FORM
