Global Village Team Member Application Form
Team Details
What Country are you applying from
Please select...
Ireland
Northern Ireland
Other
Country - other
Please select...
Canada
Germany
Spain
Ethiopia
France
Hungary
India
Italy
Cambodia
Lebanon
Malawi
Netherlands
Poland
Portugal
Romania
Slovakia
United States
South Africa
Zambia
England
Scotland
Wales
What team are you applying for?
Please select...
Building Cultural Networks Team, Romania - April 2025
See Serve Speak Kenya - June 2025
See Serve Speak Youth Romania - June/July 2025
See Serve Speak Romania - July 2025
See Serve Speak Cambodia - September/October 2025
Armagh Diocese, Romania - August 2025
Business Builds It, Cambodia - May/June 2025
What team are you applying for?
Please select...
See Serve Speak Kenya - June 2025
See Serve Speak Youth Romania - June/July 2025
See Serve Speak Romania - July 2025
See Serve Speak Cambodia - September/October 2025
See Serve Speak Youth teams will be travelling during various dates from late June to mid July. If there are any dates you are not available, please detail below.
See Serve Speak Youth teams bring together young people from across Ireland. We limit it to 4 people known to each other on each team. If there is anyone you wish to travel with, please detail names below
Please tell us why you have applied for this team?
Personal Details
Salutation
Please select...
Mr
Mrs
Ms
Miss
Rev
Dr
Other
Salutation - other
First Name
Surname
Date of Birth
Address
Town/City
County
Please select...
Carlow
Cavan
Clare
Cork
Donegal
Dublin
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Limerick
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tipperary
Waterford
Westmeath
Wexford
Wicklow
Antrim
Armagh
Derry/Londonderry
Down
Fermanagh
Tyrone
Postcode/eircode
Home Phone
Mobile Phone
Email
Passport Details
The purpose of collecting this information is to enable Habitat Ireland to book travel arrangements on your behalf. We will hold this information securely until after you have returned from your international volunteering.
Name on Passport
Nationality
Passport Number
Passport Expiry
Passport applied for & details to be forwarded to Habitat Ireland
Yes
No
NB: For some countries, your passport must be valid for 6 months beyond departure date. You will be required to give a copy of photo ID page with application
Please attach a copy of the photo ID page in your Passport
T-Shirt
Once confirmed on a team, each participant will receive a Habitat T-shirt as part of their orientation pack. Please select size and colour preference which we will endeaveour to accommodate.
T-shirt size
Please select...
S
M
L
XL
XXL
T-shirt colour
Please select...
Sapphire Blue
Kiwi Green
General Details
Occupation
Name of Company, School or place of study
Church/Parish Name (if regulary attend)
This question is optional and asked solely for church relations development
How did you hear about the Habitat Ireland International Volunteer Programme
Medical Details (Confidential)
Disclosure of your medical details does not necessarily prevent you from participating on an International Volunteering team. Any hospital or medical practicioner not having
access to your medical history may need the infomation you provide. These details will be confidential and only seen by your team leader, designated team medic and appropriate Habitat Ireland staff. This will be held securely for 5 years after your trip.
Work assignment may be physically strenuous and emotionally challenging. You should consult your doctor about joining a particular team. Please note that participants over 70 years of age, those having sought medical attention recently or those who answered yes to any of the medical questions may be required to submit written permission from their doctor.
Please detail any known medical conditions, allergies, special needs or requirements you have and if you have had any serious medical problems, illness or surgery in the last 3 years
Please detail any medication you are currently on
Please detail if you have any dietary requirements
What is your Blood Group? (if known)
Team Members are required to seek and take advice of their GP regarding necessary vaccinations. Are you willing to obtain (and pay for) any necessary
recommended immunisations and anti-malarial medication?
Please select...
Yes
No
Any other relevant information that Habitat Ireland or your team leaders should be aware of?
It is important that you inform Habitat of any prolonged illness or injury that occurs AFTER you have applied and before your date of departure
Emergency Contact Information
Next of Kin
Name
Relationship
Main Contact Number
Doctor's Details
Doctor's Name
Doctor's Phone Number
Doctor's Address
Declaration
Disclosure of details of any prosecutions or pending prosecutions does not necessarily prevent you from volunteering from Habitat Ireland. These details will be confidential and only seen by appropriate Habitat Ireland staff. The role may involve working alongside minors and vulnerable adults and we therefore need to ensure that you would be suitable for this role. Information will be held securely for 1 year after volunteering with Habitat has ended.
Do you have any convictions that are not "protected" as defined by the Rehabilitation of Offenders (Exceptions)(Northern Ireland) Order 1979 as amended in 2014?
Please select...
Yes
No
If the answer is Yes, we may need to discuss it with you. It will not necessarily prevent you from becoming a volunteer. If you wish, please give give further details below.
Gift Aid
You can boost any personal contributions by 25p of Gift Aid for every £1 you donate. Gift Aid is reclaimed by Habitat Ireland from the tax you pay for the current tax year. In order to Gift Aid your donation your must tick the 'yes' box below.
By ticking the 'yes' box below you are confirming you are a UK tax payer and understand that if you pay less Income Tax and or Capital Gains Tax than the amount of Gift Aid claimed on all your donations in that tax year. It is your responsibility to pay the difference. Please notify us if you: want to cancel this declaration; change your name or home address; no longer pay sufficient tax on your income and/or capital gains. If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code
Yes
I am not a UK taxpayer
Charitable Donation Scheme
If you donate €250 or more to a registered charity, they can claim tax relief through the Charitable Donation Scheme at no cost to the donor. Donors just need to complete a CHY 3 form.
Are you a ROI PAYE Tax Payer
Please select...
Yes
No
Data Protection
Habitat Ireland will hold the content of this application on file but will not release the information to any third party (Details will be shared with the team leaders). You can view our privacy policy at www.habitatireland.org/privacy-policy
From time to time we would like to keep you updated about how your support is making a difference to our vital work on tackling poverty housing. Please specify your contact preferences below. You can change your preferences at any time, just email info@habitatireland.org or phone +44 2892 635635/+353 1531 0033
Marketing consent (select all that apply):
Contacted by email
Contacted by post
Contacted to be contacted by telephone
Please do not contact me
Photos/Videos
During the time you volunteer with Habitat, photographs/video may be taken for general Habitat Ireland promotional purposes to include internal and external publications and websites (eg Habitat Ireland website, Facebook etc). Habitat Ireland retain all rights, title and interest in such photography and media made.
Do you consent to Habitat Ireland using your photo, video, story or quote for promotional and media purposes?
Yes
No
Confirmation
Please confirm you have read the
Terms and Conditions
I have read the terms and conditions and agree to them
If you are under 18 years of age, please provide an email address of your parent/legal guardian?
Final
Thank you for completing the application form.
If you have any questions regarding your application, please contact us at GV@habitatireland.org or contact us on +44 2892 635635
Many thanks,
The Habitat Ireland Team
Contact Information