Elective Application Form

To apply for an Elective in Tanzania through the Kilimatinde Trust, please fill in the form below copying your CV into the appropriate box.

If traveling in a group please fill in a form for each member of the group

The Kilimatinde Trust does not charge for an elective placement but we invite you to make a donation towards the trusts work. We suggest a donation of £120 would be appropriate.

Please make the donation to Lloyds Bank Hartlepool.

Sort Code: 30-99-47  Account No. 00809689   With Reference:  Elective Donation and your Name     

Iban No GB52 LOYD 3099 4700 8096 89 and the Bic No LOYD GB 21438 if required

We hold briefing / debriefing meetings twice a year in January/February and in September.

Please note that under GDPR by filling in this form you are authorising us to contact you with regard to your elective. None of your details will be used in any other way unless you authorise it.


First Name:*
Last Name:*
Address:*
Home Address:*
Mobile Phone No:*
Email Address:*
Personal Email Address:*
Please state you reasons for applying for an Elective in Tanzania:*
Please copy and paste your CV :*
Dates you are considering for you elective:*
Will you be travelling as a group:*
Yes
No
Names in your group:
Attendance at a briefing meeting:*
Yes
No
Attendance at a follow up / feed back meeting:*
Yes
No
I am willing for you to contact me after I have completed my elective by :*
Email
Telephone
Post
I would like to make a donation to the Work of the Trust:*
Yes
No
Please enter the verification number on the right:*
six five two three two
* Required Fields