Project for People – IIMC Institute for Indian Mother and Child

Surname:
First Name:
Date of birth:
Place of birth:
Gender:
Address:
Zip code:
City:
Country:
University:
Email:
Phone number:
Fax number:
Are you student?:
Professional qualification:
If you are a SISM member, please write your card number:
First choice period:
Second choice period:
Third choice period:
Fourth choice period:
Area of interest:
Other:
Important notes:
Knowledge of languages:
1. Why are you applying?
Explain your motivation. What do you expect to experience? Which chances and risks do you see:
2. Describe briefly your curriculum and skills.
If you are a medical student specify if you are a clinical or preclinical student and the expected date of graduation. Please realize that first and second year medical students are highly appreciated and will receive enormous consideration.
3. Did you help/support the Calcutta Village Project SISM– IFMSA activities or Associazione Progetto Calcutta ONLUS or IIMC in your country?
Describe your activities in details. Please realize that the project will give preference to volunteers that support the local committees and participate to meetings and activities:
4. Please explain in details how did you decide to apply to our project?
(surfing Internet? Local Committee of IFMSA? a friend who has already been in Calcutta?
Have you worked together /are you going to work with someone who has already been in Calcutta?
5. Do you smoke cigarettes?  
6. Anything else relevant to mention?  
 
Permission request according to law n. 675/96

Project for People ONLUS informs you that your personal information enjoy the rights contained in art.13 of the law 675/96;
you have the right at any time to ask for the correction, integration or deletion of your personal information, by sending an email to info@projectforpeople.org
The entity accessing the information is Project for People ONLUS, Via Angera, 3 Milano.

Having read the above statement, I authorize the use of my personal information by Project for People ONLUS.