A. Your Personal Details
Forename
Surname
Gender
Male
Female
Birth Date (Minimum Age 17) / / DD/MM/YYYY
Nationality
Your Contact Information
Email Address
Sign up to Bushwire
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegowina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, MEtropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-bissau
Guyana
Haiti
Heard and Mc Donald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
House Name/Number & Street
City/Town
County/Area
Postal Code
Daytime Phone Number
Evening Phone Number
Mobile Phone Number
How did you find out about us
Word of Mouth
I'm a past ACE Volunteer
Internet Search
gapyear.com
gapyeardirectory.com
Animal jobs direct
Volunteerabroad.com
A link from another website
Natural World magazine
Real Travel Magazine
BBC Wildlife magazine
Eco Travel Magazine
Other magazine
Higher Options Expo
Presentation
Working Abroad Expo
Bristol Festival of Nature
Adventure Travel Live
UCAS Exhibition
Other exhibition/gap year fair
National Newspaper
Other
B. Your Project Choices
First Choice
Choose a project
Tuli Conservation Project
Zingela Predator Conservation Project
Phinda Wildlife Research Project
Moholoholo Wildlife Rehabilitation Centre
Khulula Wild Care
Game Capture Team
Hanchi Conservation Project
Shimongwe Wildlife Veterinary Experience
Nholwasi Community Project
The Dolphin and Whale Research Centre
Mauritius Dolphin Conservation Project
Tutuka Family Conservation Project
Game Ranger Guide Course
Wildlife Tracking Course
Shimongwe Wildlife Veterinary Course
African Ecosystems Field Trip
Month & year of commencement
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Duration of stay
2
3
4
5
6
7
8
9
10
11
12
Weeks
Second Choice
Choose a project
Tuli Conservation Project
Zingela Predator Conservation Project
Phinda Wildlife Research Project
Moholoholo Wildlife Rehabilitation Centre
Khulula Wild Care
Game Capture Team
Hanchi Conservation Project
Shimongwe Wildlife Veterinary Experience
Nholwasi Community Project
The Dolphin and Whale Research Centre
Mauritius Dolphin Conservation Project
Tutuka Family Conservation Project
Game Ranger Guide Course
Wildlife Tracking Course
Shimongwe Wildlife Veterinary Course
African Ecosystems Field Trip
Month & year of commencement
January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
Duration of stay
2
3
4
5
6
7
8
9
10
11
12
Weeks
If there's anything else
you want to say that is relevant to your choice of projects, please add it below:
You can split your placement between projects if you prefer.
C. More about you. What are you doing now?
D. Conservation Interests
Please give details of any projects, voluntary work, membership of organisations etc.
E. Special Interests
If you are working on any special research projects, post-graduate thesis, conservation related or not, or intend following a particular career please tell us about it.
F. Your strengths and weaknesses
What do you consider to be your best and worst points? Try to be objective we all have weaknesses!
G. Hobbies and interests
Don't write a list please take one or two of your hobbies and briefly explain why you like them.
H. Your motivation
Why do you want to work in Southern Africa? What do you expect to get out of it? What can you contribute?
I. What will it be like in Southern Africa?
If you are successful with your application what living and working conditions do you expect when you get there?
J. Funding
How will you be funding your trip? Yourself? Parents or relatives? or through fund raising?
K. Expeditions and outdoor interests
Please give detail of any expeditions, adventure courses etc, successfully completed. E.g. Duke of Edinburgh, Outward Bounds etc.
L. Medical and health
Are there any medical and health issues which may affect you while you are abroad and which we need to know about? Any dietary requirements? Allergies?
M. Anything else
Is there anything else you want to add?
Important!
Please tick this box if you agree to the following:
To the best of my knowledge, the information given on this form is correct. I believe I am medically fit enough to travel to and work in Southern Africa.
Submit