Registration form for volunteers or interns
First name
*
!
Last name
*
!
Street and house number
*
!
Zip code
!
City
*
!
Country
*
!
Nothing selected
Afghanistan (افغانستان)
Albania (Shqipëria)
Algeria (الجزائر)
American Samoa
Andorra (Andorra)
Angola (Ngola)
Anguilla (Anguilla)
Antigua and Barbuda (Antigua and Barbuda)
Argentina (Argentina)
Armenia (Հայաստան)
Aruba (Aruba)
Australia (Australia)
Austria
Azerbaijan (Azerbaijan)
Bahrain (البحرين)
Bangladesh (বাংলাদেশ)
Barbados (Barbados)
Belarus (Беларусь)
Belgium (België / Belgique / Belgien)
Belize
Benin (Bénin)
Bermuda (Bermuda)
Bhutan (འབྲུག་ཡུལ)
Bolivia (Volívia)
Bosnia and Herzegovina (Босна и Херцеговина)
Botswana (Botswana)
Brazil (Brasil)
British Virgin Islands (British Virgin Islands)
Brunei (بروني)
Bulgaria (България)
Burkina Faso (Burkina Faso)
Burundi (Uburundi)
Cambodia (កម្ពុជា)
Cameroon
Canada (Canada)
Cape Verde (Cabo Verde)
Cayman Islands
Central African Republic (Bêafrîka)
Chad (تشاد)
Chile (Chile)
China (中国)
Christmas Island
Cocos Islands (Cocos Islands)
Colombia (Colombia)
Comoros (جزر القمر)
Cook Islands (Kūki Āirani)
Costa Rica (Costa Rica)
Croatia (Hrvatska)
Cuba (Cuba)
Curaçao (Kòrsou)
Cyprus (Kıbrıs)
Czech Republic (Česká republika)
Democratic Republic of the Congo (Republíki ya Kongó Demokratíki)
Denmark (Danmark)
Djibouti (جيبوتي)
Dominica (Dominica)
Dominican Republic (República Dominicana)
East Timor (Timor Lorosae)
Ecuador (Ecuador)
Egypt (مصر)
El Salvador (El Salvador)
Equatorial Guinea (Guiné Equatorial)
Eritrea (إرتريا)
Estonia (Eesti)
Eswatini (Swaziland) (eSwatini)
Ethiopia (ኢትዮጵያ)
Falkland Islands (Falkland Islands)
Faroe Islands (Færøerne)
Federated States of Micronesia (Federated States of Micronesia)
Fiji (फ़िजी)
Finland (Suomi)
France (France)
French Guiana (Guyane)
French Polynesia (Polynésie française)
Gabon (Gabonese Republic)
Georgia (საქართველო)
Germany
Ghana
Gibraltar (Gibraltar)
Greece (Ελλάδα)
Greenland (Kalaallit Nunaat)
Grenada (Grenada)
Guadeloupe (Guadeloupe)
Guam (Guåhån)
Guatemala (Guatemala)
Guernsey (Guernsey)
Guinea
Guinea-Bissau (Guiné-Bissau)
Guyana (Guyana)
Haiti (Ayiti)
Honduras (Honduras)
Hong Kong (香港)
Hungary (Magyarország)
Iceland (Ísland)
India (Bhārat Gaṇarājya)
Indonesia (Indonesia)
Iran (ایران)
Iraq (العراق)
Ireland (Éire)
Isle of Man (Ellan Vannin)
Israel (ישראל)
Italy
Ivory Coast (Côte d'Ivoire)
Jamaica (Jamaica)
Japan (日本)
Jersey (Jèrri)
Jordan (الأردن)
Kazakhstan (Казахстан)
Kenya (Kenya)
Kiribati (Kiribati)
Kosovo (Kosovo)
Kuwait (الكويت)
Kyrgyzstan (Кыргызстан)
Laos (ປະເທດລາວ)
Latvia (Latvija)
Lebanon (لبنان)
Lesotho (Lesotho)
Liberia (Liberia)
Libya (ليبيا)
Liechtenstein (Liechtenstein)
Lithuania (Lietuva)
Luxembourg (Lëtzebuerg)
Macau (澳門)
Madagascar (Madagasikara)
Malawi
Malaysia (Malaysia)
Maldives (ދިވެހިރާއްޖެ)
Mali (Le Mali)
Malta (mɐltɐ))
Marshall Islands (Aorōkin Ṃajeḷ)
Martinique (Martinique)
Mauritania (موريتانيا)
Mauritius (Moris)
Mayotte (Maore)
Mexico (México)
Moldova (Moldova)
Monaco (Múnegu)
Mongolia (mɒŋˈɡoʊliə)
Montenegro (Crna Gora)
Montserrat (Montserrat)
Morocco (المغرب)
Mozambique
Myanmar (မြန်မာ)
Namibia
Nauru (Naoero)
Nepal (नेपाल)
Netherlands (Nederland)
New Caledonia (Nouvelle-Calédonie)
New Zealand (Aotearoa)
Nicaragua (Nicaragua)
Niger (Niger)
Nigeria (Nàìjíríà)
Niue (Niuē)
Norfolk Island
North Korea (North Korea)
North Macedonia (Severna Makedonija)
Northern Mariana Islands (Notte Mariånas)
Norway
Oman (عُمان)
Pakistan (پاکستان)
Palau
Palestine (فلسطين)
Panama (Panamá)
Papua New Guinea
Paraguay (Paraguái)
Peru (Perú)
Philippines (Pilipinas)
Pitcairn Islands
Poland (Polska)
Portugal (Portugal)
Puerto Rico (Puerto Rico)
Qatar (قطر)
Republic of the Congo (Republic of Congo)
Reunion (La Réunion)
Romania (România)
Russia (Russian Federation)
Rwanda (Rwanda)
Sahrawi Arab Democratic Republic (الجمهورية العربية الصحراوية الديمقراطية)
Saint Barthélemy (Saint-Barthélemy)
Saint Helena, Ascension, and Tristan da Cunha (Saint Helena, Ascension, and Tristan da Cunha)
Saint Kitts and Nevis (Saint Kitts and Nevis)
Saint Lucia (Saint Lucia)
Saint Martin (Saint-Martin)
Saint Pierre and Miquelon (Saint-Pierre et Miquelon)
Saint Vincent and the Grenadines
Samoa (Sāmoa)
San Marino (San Marino)
Sao Tome and Principe (São Tomé e Príncipe)
Saudi Arabia (المملكة العربية السعودية)
Senegal
Serbia (Србија)
Seychelles (Sesel)
Sierra Leone (Sierra Leone)
Singapore (Republic of Singapore)
Sint Maarten (Sint Maarten)
Slovakia (Slovensko)
Slovenia (Slovenija)
Solomon Islands (Solomon Aelan)
Somalia (الصومال)
South Africa (iNingizimu Afrika)
South Korea (대한민국)
South Sudan (Paguot Thudän)
Spain (España)
Sri Lanka (ශ්රී ලංකාව)
Sudan (السودان)
Suriname (Suriname)
Svalbard (Svalbard)
Sweden (Sverige)
Switzerland
Syria (سورية)
Taiwan (Republic of China)
Tajikistan (Tajikistan)
Tanzania (Tanzania)
Thailand (Ratchana Jakratai)
The Bahamas (The Bahamas)
The Gambia (The Gambia)
Togo (Togo)
Tokelau (Tokelau)
Tonga (Tonga)
Trinidad and Tobago (Trinidad and Tobago)
Tunisia (تونس)
Turkey (Türkiye)
Turkmenistan
Turks and Caicos Islands (Turks and Caicos Islands)
Tuvalu (Tuvalu)
Uganda (Uganda)
Ukraine (Україна)
United Arab Emirates (الإمارات العربيّة المتّحدة)
United Kingdom (United Kingdom)
United States of America (United States of America)
United States Virgin Islands (United States Virgin Islands)
Uruguay (Uruguay)
Uzbekistan (Ўзбекистон)
Vanuatu (Vanuatu)
Vatican City (Città del Vaticano)
Venezuela (Venezuela)
Vietnam (Việt Nam)
Wallis and Futuna (Wallis and Futuna)
Yemen (اليمن)
Zambia (Zambia)
Zimbabwe (Zimbabwe)
Gender
*
!
female
male
various
Date of birth
*
!
place of birth
*
!
Nationality
*
!
Tel
*
!
Email
*
!
Applicant status
*
!
Pupil / Student
Intern
Social or healthcare professional
Training center or institution of origin:
!
Field of study or specialization:
*
!
Field of study or area of expertise: Type of commitment desired
*
!
Academic internship
Volunteer work (honorary)
Temporary support (field assignments)
Application as a volunteer doctor in a mission
Desired time period
*
!
Weekly working hours
*
!
full-time
part-time
Other information
!
Identity card or passport
*
!
Resume or profile sheet
*
!
Letter of motivation
*
!
Certificate from the institution (for internships)
!
Declaration of consent
*
!
I consent to my personal data being processed exclusively for the purposes of the application process and within the scope of my work in Benin. The data will not be passed on to third parties. Processing will be carried out in accordance with the provisions of the General Data Protection Regulation (GDPR). I am aware that I can revoke my consent at any time with future effect.
Please wait
Submit form