Name
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First Name
Last Name
Gender
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M
F
Other
Prefer not to say
Date of Birth
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MM
DD
YYYY
Ocupation
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Country
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Passport Number
Expiration Date
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Telephone
*
Country
(###)
###
####
Email
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For which volunteer cycle AND program are you applying?
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How did you hear about our program?
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1. At what level do you consider your Spanish speaking skills?
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2. Do you plan on participating in the afternoon political-cultural program? If so, what are your interests for this program?
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3. Do you plan on taking Spanish classes? If so, what dates do you plan on attending?
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4. Have you studied Spanish or other languages before? Please describe.
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1. What are your housing preferences?
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2. Do you need any of the following housing options?
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Other:
3. What are your smoking preferences?
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4. Do you have any dietary restrictions? (check all that apply)
Food allergy (specify):
Other (specify):
5. Do you have any allergies to medicine?
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If yes, specify:
6. Do you have any health problems/restrictions? (incl. asthma, migraines, etc.)
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a. If yes, in what way are you managing it? (i.e. inhaler, insulin, etc)
b. If yes, what additional accommodations can we provide to help?
8. Are you currently taking any medication?
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If yes, specify
1. Do you have any special skills (technical, health care, teaching ESL, computers, farming, business etc.)?
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2. Have you been active in community, international solidarity, or political organizations or parties? Please describe.
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3. Have you traveled to Latin America or elsewhere? If so, where, when, and what did you do?
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4. Do you have any experience with teaching English, or with popular or community education?
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5. Why do you want to participate in this program? What do you hope to get out of the experience?
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6. Please share with us your views on Central American issues.
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