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Programmes for the following reasons: Special skills or other comments: Declaration: To the best of my knowledge, the information I have provided about the Applicant is true, accurate and complete. I am not aware of past/present behaviour by the Applicant that would disqualify him/her from working with international youth, acting as an appropriate role model or functioning in a position of trust with CISV. (Day / Month / Year) Referee s Signature Confirmation of previous Reference: Please s.

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