Prospective Participant Self-Evaluation

Thank you for expressing interest in working with Clowns Without Borders!  We are always on the lookout for new participants who can help bring laughter and emotional relief to areas around the world.  CWB projects are often very rigorous both physically and psychologically.

So that you can have an idea of what it takes to be a participant on expeditions AND so that we can know whether you may be suitable for future missions, please take the time to fill out this self-evaluation.

Order Number

First Name *

Last Name *

Email Address *

Address *

City *

Contact Number *

Alternate Contact Number

Age *

Home Language *

Country *

Select a country Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Reference 1

Name *

Email Address *

Contact Number *

Relationship *

Reference 2

Name

Email Address

Contact Number

Relationship

To simplify matters, we have created a scale system to use in the following assessment:

0 = No experience
1 = Very little experience
2 = Some experience
3 = Experienced
4 = Very experienced
5 = Master

Performance Experience

From 0 to 5, please rate your experience in the following performance areas:

1. Clown

0 1 2 3 4 5

Please specify where you have had clown experience and for how many years. (Circus, theatre, street, party, workshops). Do you have a developed character?

2. Circus

0 1 2 3 4 5

Please specify your skills. (juggling, stilts, acrobatic, etc.)

3. Drama

0 1 2 3 4 5

Please briefly describe.

4. Other

0 1 2 3 4 5

Please briefly describe other performance experience you may have (dance, storytelling, music).

5. What is the largest audience you have worked for? Average audience size?

Teaching Experience

From 0 to 5, please rate your experience in the following performance areas:

1. Adults

0 1 2 3 4 5

2. Children

0 1 2 3 4 5

3. Circus/Drama

0 1 2 3 4 5

4. Trauma-related situations

0 1 2 3 4 5

5. Story-telling

0 1 2 3 4 5

6. Other Teaching Experience

0 1 2 3 4 5

Please specify what areas you have taught, approaches/pedagogies, length of time, and population demographics.

7. Languages: Please list which languages you can speak and whether you are fluent, proficient, adequate, or just a mumbler!

8. Other Experience: Please specifiy and elaborate.

Personal Character Assessment

1. What is your intention in volunteering on Clowns Without Borders expeditions?

2. What do you believe are some of your strengths?

3. What are some of your challenges?

4. How would you describe your ability to work with a team?

5. How do you describe your ability to cope with the stress of demands of traveling and performing in unfamiliar circumstances?

6. Can you work away from home on expeditions between 2 weeks and a month?

Additional information

7. Can you drive? *

Yes No

Your Website Link

8. Do you have a valid driver's license? *

Yes No

Your Youtube Profile

Upload CV

Add File Please upload your CV in PDF format.

Information Summary