APPLICATION FORM

PRISON OUTREACH MINISTRY & VOLUNTEERING CENTER
P.O. BOX 6834-00200 NAIROBI , KENYA. EAST AFRICA
www.prisonoutreachministrykenya.blogspot.com
Email: prisonoutreachministry@yahoo.com
Tel. 254-727-241025

APPLICATION FORM

1. Name: -----------------------------------------------------------------------------------------

2. Address: --------------------------------------------------------------------------------------

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2.1 Telephone: Office________________________House__________________
Mobil__________________________________________________
2.2 Email:___________________________________________________________
2.3 Fax _____________________________________________________________

2.4 Physical ________________________________________________________
Address __________________________________________________________
3. Sex: Male / Female
4. Marital Status: Married Single Divorced Separated
5. Date of Birth: D. ___ M. ___ Y._____
6. Your Profession / Calling: _____________________________________________
7. Church Affiliation: ___________________________________________________
8. Citizen: _____________________________________________________________
9. Country of Residence: _________________________________________________

10. Personal Skills : ____________________________________

11. Category of Volunteer Applying for: ____________________________________

12. Duration of Placement / Volunteer Applying for:
1-Week 2-Weeks 3-Weeks 1-Month 2-Month 3-Month
Other___________________
13. Month and Dates you wish to Minister / Volunteer:
_________________________

14. Your Pastor’s, Bishop’s, Leader’s, Other's Name: __________________________

14.1. Address: _______________________________________________________

14.2. Telephone: Office: _________________ Mobile: _________________

House: __________________
14.3. Fax: ________________________ 14.4. Email: ______________________
14.5 Recommendation Letter from either of No. 14. (200 words)

15. Have you been to Kenya or any of the East and Central Africa countries?
Yes No

If Yes, which city and country?_______________________________

16. A short history about yourself (200 words) Use a different sheet of paper.
17. Your Hobbies: _____________________________________________________

_____________________________________________________
18. Your Comments; ___________________________________________________
____________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Date: _________________ Sign: ______________________________

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