Period of Service Interest Form Instructions This interest form is intended for those who are exploring possibilities of offering a period of service to the Atlantic Region (DC, DE, MD, VA). Please provide as much information as possible.First Name *Last Name *Date of Birth *MM/DD/YYYYPhone *Email *Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryIf an enrolled Bahá’í, please provide your Bahá’í ID# When can you begin your period of service? *MM/DD/YYYYWhat is the period of your commitment? *(For example: one year, two years, six months, etc.)What type of financial support is available to you during your dedicated period of service? Outline financial resources.Will you have access to a car during your period of service? (Y/N) YesNoDriver's License Issuing State and License NumberIn order to serve in the Atlantic region, health insurance is mandatory. Do you currently have health insurance? (Yes/No) YesNoHealth Insurance Provider Please provide the name of your health insurance companyU.S. Citizen? YesNoMarital Status SingleMarriedMarried with childrenLanguage(s) Spoken (Please list any languages in which you feel comfortable communicating and conversing with others, for example, in the context of a home visit or study circle.) Training Institute Courses, Core Activities, Other ServiceRuhi Book 1 - Reflections on the Life of the Spirit Completed? YesNoTutored? YesNoRuhi Book 2 - Arising to Serve Completed? YesNoTutored? YesNoRuhi Book 3.1 - Teaching Children’s Classes (Grade 1) Completed? YesNoTutored? YesNoRuhi Book 3.2 - Teaching Children’s Classes (Grade 2) Completed YesNoTutored? YesNoRuhi Book 3.3 - Teaching Children’s Classes (Grade 3) Completed? YesNoTutored? YesNoRuhi Book 3.4 - Teaching Children's Classes (Higher Grades) Completed? YesNoTutored? YesNoRuhi Book 4 - The Twin Manifestations Completed? YesNoTutored? YesNoRuhi Book 5 - Releasing the Powers of Junior Youth Completed? YesNoTutored? YesNoRuhi Book 6 - Teaching the Cause Completed? YesNoTutored? YesNoRuhi Book 7 - Walking Together on a Path of Service Completed YesNoTutored? YesNoRuhi Book 8 - The Covenant of Bahá'u'lláh (Unit 1) Completed? YesNoTutored? YesNoRuhi Book 8 - The Covenant of Bahá'u'lláh (Unit 2) Completed? YesNoTutored? YesNoRuhi Book 8 - The Covenant of Bahá'u'lláh (Unit 3) Completed? YesNoTutored? YesNoRuhi Book 9 - Gaining an Historical Perspective (Unit 1) Completed? YesNoTutored? YesNoRuhi Book 9 - Gaining an Historical Perspective (Unit 2) Completed? YesNoTutored? YesNoRuhi Book 9 - Gaining an Historical Perspective (Unit 3) Completed? YesNoTutored? YesNoRuhi Book 10 - Building Vibrant Communities (Unit 1) Completed? YesNoTutored? YesNoRuhi Book 10 - Building Vibrant Communities (Unit 2) Completed? YesNoTutored? YesNoRuhi Book 10 - Building Vibrant Communities (Unit 3) Completed? YesNoTutored? YesNoRuhi Book 11 - Material Means (Unit 1) Completed? YesNoTutored? YesNoPlease describe your facilitation experience with the education imperatives Tutoring populations through the sequence of courses - which books and which populations; Animating Junior Youth Groups - Which texts have you covered in your groups?; Teaching Children's Classes - Which grades have you taught?Please describe your involvement in the other core activities of the Bahá’í community: Please describe any other experience with service, Bahá’í or otherwise: (This may include service on Local Spiritual Assemblies or other Bahá’í institutions, national or cluster agencies or committees, previous pioneering or travel teaching experience, giving firesides or deepenings, community service, working with children or youth, etc.) Other FactorsIn what capacity do you envision serving the Atlantic Region? Are there any other factors that will need to be considered for you to undertake this service? (If yes, please provide detail of these needs. For instance, health concerns, family responsibilities, etc.)What are your current plans, if any, about what you will do after your period of service? (For example: Do you plan to go to a university? Are you open to continuing a path of service in the same area?)Please provide a reference who can comment on your engagement in service: (Please include reference's name, title/position/relationship to you, phone number, and email address.)Reference Email Reference Phone VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: