Peace Corps Guyana

Volunteer Request Form

Instructions: Please complete all sections and return to Peace Corps Guyana via the following options:
Post to:
U.S. Peace Corps Guyana
Director of Programming and Training
P.O. Box 101192
Georgetown, Guyana

Hand-deliver to:
U.S. Peace Corps
33 A Barrack St.
Kingston, Georgetown

Email to:
pcgy_desk@gy.peacecorps.gov

SECTION 1: ORGANIZATION OVERVIEW

1.1 Organization Contact Information
Full Name of Organization (include acronym):
Community Name:

Admin. Region:

Sub-Region:

Full Mailing Address:

Telephone Number(s): __ _________
Email Address (es):

Radio Frequency of Agency: _____________

_________________________

__

______

1.2 Head of Organization Information

Name of Head of Organization:_______________________
Direct Contact: __

__________

Mobile #:

Email Address:

Alternative Contact #:
Website:

1.3 Organization Profile

Organization Type: Please tick which one applies
Primary School Primary Tops REDOs Office Other Ministry of Education department Tertiary/Vocational Institution
Secondary Institution Local or Community-based NGO International NGO Regional Hospital Cottage Hospital Health
Centre Health Post/Hut Other

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Briefly describe the organizations history (i.e., year established, details on founding members, key partners in the
community, etc.)

Briefly state the organizations mission/goals/priorities:

Describe the organizations major activities (past/present/continuous) and how they relate to your
mission/goals/priorities:

How does the organization involve these targets (as well as community members on the whole) in the organizations overall
activities?

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SECTION 2: COMMUNITY OVERVIEW

2.1 Location: Describe the location of your Community. Include village/community zones, nearby villages and towns and the
distance/time it takes to get to these.

2.2 Community History: Describe the social, cultural and political history and development of your community.

2.3 Community Leadership: Does your community have a defined leadership structure? (Example: a Toshau and Village Council
or Village Elder)

2.4 Population of Community:

a.

Approximately how many people reside in your community? _________

b.

What is the general make-up of your community? (For example: Predominantly female Amerindians under the age of 30)

2.5 Community Priorities: Please list the top development priorities and needs of your community.

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2.6 Organizational Response: How is your organization (or any other Community group) currently addressing these
needs/priorities?

2.7 Accommodation:
a.

Do you know of any available Housing/Host Family options that Peace Corps can consider? Yes No
If yes, please give details (name, phone number, address, housing description, etc.)

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SECTION 3: VOLUNTEER ASSIGNMENT

Peace Corps Guyanas Volunteers function within the Health and Education Sectors, which is guided by our Project Frameworks. The
primary activities within which Volunteers are engaged should align with these. See the table below for a summary of the focus of
these sector frameworks:

HEALTH PROJECT PURPOSE

Guyanese will lead healthier lives.

Goal 1: Maternal, Infant, and Child Health Promotion

Community members will adopt behaviors and practices that contribute to improved maternal, neonatal, and child health outcomes.
Objective 1.1. Maternal & Neonatal Care: Individuals, especially mothers, will adopt practices that lead to healthy pregnancies, safe deliveries,
positive birth outcomes and healthy infants.
Objective 1.2. Nutrition: Women will adopt healthier infant and young child feeding practices resulting in improved nutritional status.
Objective 1.3. Prevention of Childhood Illnesses: Community members, especially mothers and/or caregivers, will adopt evidence-based
practices to safeguard the health of their children.
Objective 1.4. Service Provider Capacity Building: Service providers (health center/post staff, RHO office staff, hospital staff) will adopt new
practices to increase health-seeking behaviors and improve service delivery that lead to positive health outcomes for mothers and children.
Goal 2: Life Skills for Healthy Behaviors
Community members will adopt positive lifestyle-related behaviors and practices that lengthen and/or improve their overall quality of life.
Objective 2.1. NCD Prevention/Mitigation: People (children, youth, and adults) will adopt new behaviors to reduce the risk for developing noncommunicable diseases and/or reverse or mitigate the impact amongst those who have one or more non-communicable diseases.
Objective 2.2. Life Skills: Youth will demonstrate improvement in at least 3 out of 5 key life skill areas including positive identity, communication,
decision making, goal setting skills, and strategies to support emotional health.
Objective 2.3. Youth Sexual & Reproductive Health: Youth will use their new sexual and reproductive health knowledge and skills to make
healthy, informed decisions about their health and sexual well being.
Objective 2.4. Substance Use Prevention: Youth will mitigate the harmful effects of alcohol and other substances as a result of increased
awareness and adoption of healthy lifestyle choices.

EDUCATION PROJECT PURPOSE

Students, teachers and community members will gain access to personal, professional, and academic development opportunities
through literacy.
Goal 1: Improve Teaching
Teachers will implement more effective and responsive literacy instructional techniques.
Objective 1.1: Improve Teachers Literacy Instructional Practice: Primary school teachers will implement more student-centered
literacy instruction, effective and equitable classroom management techniques, classroom based assessment, instruction of critical
thinking skills and/or content based instruction.
Objective 1.2: Improve Resource Development and Utilization: Primary school teachers will develop additional material
resources, or introduce new or better ways to preserve and utilize existing resources.
Goal 2: Increase Student Success
Students will improve literacy skills, thereby raising academic success.
Objective 2.1: Improve Literacy Achievement and Participation in Classes: Primary school students will show improved
achievement and confidence in literacy skills and increased participation in classes.
Objective 2.2: Improve Student Achievement, Participation, and Leadership Skills through Extracurricular Activities:
Primary school students will show improved academic achievement and increased participation and/or leadership skills in one or
more extracurricular activities.
Objective 2.3: Expand Use of Library and/or ICT Resources: Primary school students will have improved access to library and/or
electronic resources.
Goal 3: Improve School, Family and Community Partnerships
Community members will increase participation in community and family learning initiatives.
Objective 3.1: Enhanced School Environment
School community members, including primary school students and teachers, will participate in activities that enhance the school
environment for literacy instruction and learning.
Objective 3.2: School and Family-focused Community Projects
Community members, especially families, will participate in activities that enhance and support learning.
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3.1 Volunteers Work/Reporting Opportunities: Considering the above table, please list which Goals/Objectives Volunteers
will have the opportunity to work within, if placed at your organization.

3.2 Volunteers Primary Assignment: In bullet format, list the major duties, activities and responsibilities of the Volunteers
primary job assignment.

3.3 Knowledge, Skills and Attitudes (KSAs): List the Knowledge, Skills and Attitudes the Volunteer must have in order to
undertake the major duties described above.
Knowledge:
Skills:
Attitudes:
3.4 Secondary Opportunities: In examining your communitys needs, what other project opportunities/collaborations may
the Volunteer consider within your organization or within the wider community? Please tick all that are relevant:
Youth as Resources
Gender Empowerment
HIV/AIDS Projects
Technology for Development
Other:
Please provide details on the project opportunities indicated above:

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3.5 Describe/Illustrate the organizational hierarchy and then indicate where the Volunteer is expected to fit in.

3.6 What resources will the volunteer have at his/her disposal? (For example: will the Volunteer have access to an office,
shared space, shared desk or computer, internet?)

3.7 Describe the codes of conduct to which the Volunteer working in your agency must adhere. (Detail the dress code,
work hours, general office operations including leave, meetings and reporting, etc)

3.8 Please describe the general work demands for this assignment. (For example, does the position require physical
exertion or travel? How much time will the Volunteer spend in and out of office?)

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SECTION 4: COMMUNITY CONTACTS

4.1 Please list key community contacts and groups: (List as many as you can who are key resource persons, whether for
work/project-related purposes or overall community integration)
Name (of person or Organization)

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Details (Position/Contact Information)

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SECTION 5: Supervisor and Counterpart Information

The Volunteers Supervisor is expected to provide overall guidance on the general job description of the volunteer.
The Volunteers Counterpart is expected to provide regular and consistent guidance and support to the volunteer as it relates to
delivery of his/her day-to-day work responsibilities and cultural integration and immersion within the community as well.
Note: ATTENDANCE AT CONFERENCES - Supervisor(s) and/or Counterpart(s) will be expected to attend two workshops:
one prior to the volunteers arrival in the village/community to which he/she is assigned (Counterpart Conference) and
another 3-4 months into service (Reconnect/Project Design and Management). Peace Corps Guyana will provide
accommodation (at an arranged hotel and only for the duration of the workshop) for supervisors and counterparts attending
these conferences as long as these persons are coming from rural areas and require accommodation.
Who will the Volunteers Supervisor be?

Position:

Who will the Volunteers primary Counterpart be?

Position:

Who else will the Volunteer work directly with? Give information below.
Name:

Position:

Telephone:

Name:

Position:

Telephone:

Name:

Position:

Telephone:

Name:

Position:

Telephone:

Please list other members of your agency/community who are involved in this Volunteer request process (list their names and
include their signatures and contact information):
Name:

Signature:

Telephone:

Name:

Signature:

Telephone:

Name:

Signature:

Telephone:

Name:

Signature:

Telephone:

____________________________________________
_
Print Name & Signature of person completing this form

Date

Position/Title within organization or community

Date

Peace Corps Program Manager signature

Date

Peace Corps Programming & Training Specialist signature

Date

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