|
|
|
|
|
|
Please complete the brief survey below (estimated time burden: 4 minutes). This information helps us respond to future inquiries, and will be kept strictly confidential. When you submit the information, you will be redirected to application instructions. NOTE: If you have not served in the Peace Corps, you are not eligible for this program. Please see http://www.peacecorps.gov/ for more information about opportunities with the Peace Corps.
|
First Name:
|
|
|
Last Name:
|
|
|
Email:
|
|
|
Current Phone Number:
|
|
|
Permanent Phone Number:
|
|
|
Preferred Method of Contact:
|
|
|
Current Mailing Address (Street, City, State, Zip, Country):
|
|
|
Permanent Mailing Address: (Street, City, State, Zip):
|
|
|
Area of Intended Specialization/Academic Subject Area:
|
|
|
How did you find out about the Peace Corps Fellows Program at Teachers College?:
|
|
|
If you chose "Other," please explain how you heard about our program:
|
|
|
Have you ever served as an AmeriCorps member?:
|
|
|
Peace Corps Country of Service:
|
|
|
Peace Corps Dates of Service (MM/DD/YY) to (MM/DD/YY):
|
|
|
Peace Corps Job Title/Description:
|
|
|
If you have not served in the Peace Corps, would you like to be contacted by a regional Peace Corps recruiter?
|
|
|
Undergraduate Institution and Major:
|
|
|
Comments or Questions (If you need a hard copy of the application mailed to you, please state so here):
|
|
|
|
|
|
|
