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Blue Simple Dental Clinic New Patient Form A4 Document - 20250529 - 134739 - 0000

The document is a candidate information form for Vebex India Foundation, collecting personal details, donation preferences, skills, references, and volunteer interests. It also includes sections for availability and a declaration of truthfulness regarding the provided information. The form aims to gather relevant information from potential members interested in joining the NGO and contributing to its mission.

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equipmentkarate
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0% found this document useful (0 votes)
7 views2 pages

Blue Simple Dental Clinic New Patient Form A4 Document - 20250529 - 134739 - 0000

The document is a candidate information form for Vebex India Foundation, collecting personal details, donation preferences, skills, references, and volunteer interests. It also includes sections for availability and a declaration of truthfulness regarding the provided information. The form aims to gather relevant information from potential members interested in joining the NGO and contributing to its mission.

Uploaded by

equipmentkarate
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Vebex India Foundation


Candidate Information
First Name: Last Name:
Birth Date: Gender: Male Female
Address:
City: State: ZIP
Email: Cell Phone:
Marital Status: Married Single Divorced Widowed Other
Age: Phone:
Blood group:
How did you hear about us?
I live/work in area I was referred by
Social media Other

Donation
- Would you like to make a donation to support our work? (Yes/No)
- If yes, please specify the amount: ₹ _______________________.

- Would you like to set up a recurring donation? (Yes/No).


- If yes, please specify the frequency: _______________________.

Skills and Expertise


Do you have any skills or expertise that could be useful
to our organization? (e.g. marketing, fundraising, event,
planning, graphic design, writing, etc.)
- Please specify ________________________________________________
__________________________________________________________________.
__________________________________________________________________
__________________________________________________________________
[ Please attach a copy of your ID proof (Aadhaar Card, Driving License, etc.) ]
[ Please attach a passport-sized photograph ]

Candidate Signature Date


References
- Have you been referred by anyone? (Yes/No).
- If yes, please provide their name and contact details: __________________________________________________________________
______________________________________________________________________________________________________________________________
Why do you want to join vebex India Foundation?
- (Please provide a brief description of your interests and motivations for joining our organization, and how you
think you can contribute to our mission) : ___________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Are you proficient in any languages other than English? (Yes/No)
- If yes, please specify: ______________________________________________________________________

Volunteer Interests
- What areas of our work would you like to volunteer in? (e.g. animal welfare, women's
empowerment, education, environmental conservation, etc.).
- Please specify: ___________________________________________________________________________
- Are you willing to participate in fieldwork? (Yes/No)
- Are you willing to participate in office work? (Yes/No)

Availability
- How many hours per week/month can you dedicate to.
volunteering?- _______________________________________________________
- Are you available to volunteer during weekends? (Yes/No)
- Are you available to volunteer during weekdays? (Yes/No)

Declaration
- I hereby declare that the information provided is true and accurate
to the best of my knowledge.
- I understand that membership is subject to approval by the NGO's
management team.
- I agree to abide by the rules and regulations of vebex India
Foundation.
Agree

This updated form focuses on collecting relevant


information from potential members and allows them
to express their interest in joining the NGO.

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