Personal Information

How did you hear about ISWS? (Please explain what search lead you to our website)

Name:

Home Address:

(For MSW student) School Address:
Home Telephone:
Cell Number:
Work Number:
Email Address:

Gender:MaleFemale

Date of Birth:

Country of Birth:

Education:

High School:

Year Graduated:

City/State of High School:

College or University:

Year Graduated:

City and State of College:

Degree Awarded:

Post-Graduate Institution:

Year Graduated:

City/State of Post-Graduate Institution:

Degree Awarded:

Additional Education, Certification or Training:

Previous International Travel:
Languages Spoken:
Emergency Contact Information:
Name:
Address:
Telephone Number:
Email:

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

(By submission of this Application you agree and authorize ISWS to obtain CORI and SORI reports.)

Accept:

Have you ever had your social work license suspended? If so, please explain.

Have you ever had a malpractice suit filed against you? If so, please explain.

Project Details

Location of Project (City and Country):

Project start date : and end date:

Budget:

Please attach proof of airfare, housing, and any other documentation listed below.

Please list your expected expenses (in U.S. dollars) for the following:

1) Project Fees if any

2) Roundtrip Airfare

3) Local transportation

4) Passport and/or VISA fees

5) Housing and Meals

6) Travel Insurance

7) Miscellaneous

Total Expenses (in U.S. dollars):

Explain why you are seeking financial assistance and whether you will be receiving any other funding to complete the stated project. If you are receiving additional funding, please explain the details:

Project Description: (Please be as detailed as possible. Include goals, major daily activities, resources needed, tools, supplies, time frame for achievable results, and any other pertinent information)

Personal Essay

On a separate document of no more than 2 pages, provide the following: Give a brief overview of the volunteer work you will be engaged in. Describe the projected impact of your international volunteerism on the population/organization you are serving. What is your motivation for pursuing international volunteer work? Describe any previous international volunteering positions and how it influences your social work in the U.S. What specifically do you hope to learn from this experience?

International Agency Contact Information:

Address of NGO/Agency:
Contact Name:

Attach confirmation of participation from the international organization involved.

Contact information of Professional References: (need 2 professional references)

1) Name:
Address:

Work Number:
Cell Number:
Email address:
Relation to Applicant:

2) Name:
Address:

Work Number:
Cell Number:
Email address:
Relation to Applicant:

Agreement

By submitting my signature and email address, I certify and agree that:
- All the information I have provided in this application is truthful and accurate.
- If awarded the ISWS stipend, I understand that I will submit a written report upon completion of my volunteer program with photos and/or videos. I acknowledge that I will receive 80% of the stipend prior to program travel and the remaining 20% upon return and submission of a written report with photos.
- My report and any photos/videos I submit will become the property of ISWS and may be used in promotional materials.
- I agree to provide ISWS with a daily accounting of expenses such as housing, food, activities, and incidentals. It should be noted, that the ISWS recipient will be asked to return any unused stipend money. As well, if travel and project costs exceed expected amounts, ISWS will consider reimbursing the applicant for the cost differential.
- I understand that my application will only be considered if all the materials requested are completed.
By submission of this Application, I specifically release and forever discharge International Social Work Solutions Inc from and against any and all liability, damage, personal injury, costs, and the like, and specifically my personal welfare during my participation in any program abroad. ISWS assumes no responsibility or obligation beyond providing the stipend.

Accept:

Email address:

Application Submission Date:

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