Individual Form

Help CenterCommunityIndividual Form

“Be Our Friend”

Dear Interested,

Please Fill Out The Application Below:

    Personal information

    Full Name:

    Gender:

    Nationality:

    Age Group:

    Telephone No:

    Mobile No:

    Fax No:

    Best Time to Reach you:

    Email:

    How often do you check your E-mail messages?

    Education: Background

    Education:

    Languages:

    Have you had previous experience in communicating with intellectual disabled Persons?

    If Yes Explain please:

    Are you willing to “Be our Friend” at Dirat Ajdadi alumni club (18 years and Above - different venue - different hours)?

    Any Hobbies or Interests?

    For how long would you like to be with us?

    In which days would you like to be with us?

    Programs of Interest
    With children

    Office work

    In Case of Emergency

    Name:

    Telephone/Mobile No:

    Address:

    Name:

    Telephone/Mobile No:

    Address:

    Do you have any comments or ideas you think we should add to “Be our friend” form?

    Why did you select the Help Center to "Be Our Friend"?

    Thank you for your interest to “Be Our Friend” at the Help Center