VOLUNTEER PROGRAM
APPLICATION FORM

This is an application for both the Community Resident (a 17-week commitment)
and for the Standard Volunteer.

Name_________________________________________________________________________

Address_______________________________________________________________________

City___________________________ State________ Zip_______________

Telephone (Day)___________________________ (Evening)______________________

Email_________________________________________________________________________

WHICH OPTION ARE YOU INTERESTED IN?

CRV____ STANDARD____

What is your preferred start date? Month__________________ Year__________________
end date? Month__________________ Year__________________

Are these dates flexible?________________________________________________________

Do you have the energy level to work actively for a full 40 hours per week?______

Do you have sufficient money for general expenses during your stay?______

Are you fluent in spoken and written English?______

What is your previous experience with macrobiotics? (cooking, education, employment)

______________________________________________________________________________

______________________________________________________________________________

Is there a particular area in which you would like to work? (You can mark more than one.)

_____ Housekeeping _____ Grounds/Maintenance
_____ Kitchen _____ Office
_____ Conferences & Events _____ Store/Warehouse

Please describe your experience for the area(s) you have indicated.

______________________________________________________________________________

______________________________________________________________________________

On an attached piece of paper, please write why you want to be a part of this program.

REFERENCES

Please provide the names and daytime telephone number of three work references:

1. Name____________________________________ Tel:__________________________
Company_________________________________ Relationship___________________

2. Name____________________________________ Tel:__________________________
Company_________________________________ Relationship___________________

3. Name____________________________________ Tel:__________________________
Company_________________________________ Relationship___________________

By signing below, I acknowledge that:
1. The information I have provided on this application is true and correct to the best of my knowledge.
2. I understand that providing false information on this application could result in my immediate dismissal from the program with no refund of monies paid.

Signature_______________________________________ Date__________________________

PLEASE USE THE FOLLOWING CHECKLIST TO INSURE YOU ARE INCLUDING ALL NECESSARY INFORMATION AND DOCUMENTS BEFORE RETURNING YOUR APPLICATION:

_____ Completed and Signed Application Form
_____ Copies of Valid Identification:
(social security card or certified copy of birth certificate and driver's license) or (passport)
_____ Letter describing why you would like to be a part of this program
_____ Current resume (unless you are a student, and in that case, your student history)
_____ $35.00 Application Fee

Please note: Due to United States governmental regulations we can only accept volunteers who are U.S. citizens or have U.S. green cards or working permits. Foreign students are encouraged to join our other programs.

Please return the completed application form and required documents to:

Kushi Institute OR Fax (413) 623-8827
Attn: Volunteer Coordinator
198 Leland Road
Becket, MA 01223-0007