Registration

If you are interested in joining the Peace Planet work-study program, please complete the form and click the send button at the end.

First name:

Family name:

Address 1:

Address 2:

Zip code:

City:

Country:

Phone (daytime):

Phone (evening):

Mobile:

E-mail:

Date of birth:

Place of birth:

Sex:

Female Male

Nationality:

Religion:

Marital status:

Single Married Divorced

Name of partner:

Number of children:

Age of children:

What is your education?

What is your profession?

Which languages do you speak/write?

Do you have any particular skills?

Please mention you hobbies.

Are you able to work 40 hours a week?

Yes No

Do you have any health problem?

Yes No

Do you use drugs and/or medication?

Yes No

If yes, what kind?

Do you have any experience in macrobiotics?

Yes No

If yes, please describe.

Do you have any experience in natural food?

Yes No

If yes, please describe.

Do you have any experience with food production?

Yes No

If yes, please describe.

What are your personal strengths?

How would you like to improve yourself?

What are your goals in life?

What do you expect from your stay with us?

Do you have enough money for a ticket to Holland?

Yes No

Did you read the information on this web site carefully and do you agree with the conditions of the work-study program?

Yes No

Can you accept a simple room?

Yes No

Are you willing to share a room with someone else?

Yes No

Which kind of activities would you like to take part in?

Taking care of children
Cooking
Cleaning and laundry
Home production of macrobiotic food
Filling grains, beans, seeds, etc.
Organic gardening
Fixing the house and shop
Working on the market
Working in the shop

What would you like to learn about during your stay with us?

Macrobiotic cooking and philosophy?
Dutch

From which date you can come to Holland?

How long do you want to stay?

Do you want to come with someone else?

Yes No

If yes, who? (please provide their name here and send a second form).

Please write a short account of your life story so far.

Do you have any questions that have not been answered on this site?