Name: * Nationality: Country: Birthdate: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008 Sex: * Female Male N/A Contact Email: * Phone: Address: Profession/Title: Including Office if any. Volunteer Work: Site Location: * Kaolack Thies Louga Dakar Desired Starting Date: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202320242025 Duration: Planned Date fo Arrival to Senegal: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202320242025 Spoken Language(s): * Homestay Homestay Desired?: * Yes No N/A Homestay Duration: Would You Be Willing to Share a Room?: No Yes N/A Would You Prefer to be Placed with Another Student or By Yourself?: With Another Student By Myself N/A Do You Smoke?: No Yes N/A Can You Live with Smokers?: No Yes N/A Food or Dietary Restrictions, if any: Please Briefly Describe Yourself and Your Own Family: Airport Pickup Arrival: Yes No N/A Departure: Yes No N/A
