STA Travel Application Form

Please take a few minutes to fill out your relevant details so ISV may review your application to travel this summer.

*required fields

Full legal name that will appear on the passport

Press "Enter" or "Tab" to move cursor to next field.

Last Name*	First Name*	Middle Name	Nickname

Street Address (while you're in school)*	City*	State*	Zip*	Country*
Permanent Address (while you're in school)	City	State	Zip	Country

Cell Phone # [XXX-XXX-XXXX]	Email [Email@Domain.com]*	Age*	Gender*
			Male     Female

Home Phone # [XXX-XXX-XXXX]*	Alternate Email Address [Email@Domain.com]	Date of Birth*
		[MM-DD-YYYY]
Country of Birth*	Country of Residence	Citizenship*

Emergency Contact 1*	Relationship*	Phone*	Email Address
Emergency Contact 2	Relationship	Phone	Email Address
University (if applicable)	University Major (if applicable)	School Year

Freshman Sophmore Junior Senior Graduated Not a Student

Heath Questions

Do you have any physical disabilities?* If so, please explain.	Yes     No
Do you have any allergies?* If so, please explain.	Yes     No
Do you take any prescribed medications?* If so, please explain.	Yes     No
Do you have any special dietary needs?* If so, please explain.	Yes     No
Are you a returning ISV participant?* If so, please explain.	Yes     No

Do you speak Spanish?

Yes     No

If so, how proficiently?

Beginner Intermediate Advanced Fluent

T-Shirt size

Small Medium Large X-Large XX-Large

PROJECT PREFERENCE: Check the boxes that apply below. Remember, the more flexible you are, the easier it will be for ISV to reserve a place for you. (Your actual project will be assigned one month prior to departure to your host country).

	I am willing to do anything and have no project preference.
	I would like to participate in a conservation project. Australia, New Zealand, Costa Rica, Ecuador and Thailand
	I would like to participate in a social community development project. Costa Rica, Dominican Republic, Ecuador and Thailand.

Please state full name of any student(s)/friend(s) you would like to be placed with, as well as the name of the university they attend.

HOST COUNTRY: In the spaces provided number each country in order of preference ("1" is your first country preference). Then, check all the departure dates on which you are available to travel for each Program. Remember, the more flexible you are the easier it will be for ISV to reserve a place for you.

DATE OF DEPARTURE:*

 

I am interested in:

	5-day Spanish Language and Latin Dance Lessons prior to the start of the ISV Program in Costa Rica/Dominican Republic/Ecuador.
	Optional Fiji 5-day Excursion at the conclusion of the ISV Program in Australia/New Zealand.
	One-week Galapagos Island Excursion at the conclusion of the ISV Program in Ecuador.
	How to receive donations from sponsors in my community that will go towards offsetting the cost of my Program.
	Earning Academic Credit. Note: Students are responsible for determining in advance the transferability of units to their home school. There will be anadditional cost for Academic Credit paid to the accrediting University, not ISV.

 

Are you a US or Canadian Student?*

USA      CAN

LIABILITY AGREEMENT: I VERIFY THAT ALL THE ABOVE INFORMATION IS CORRECT; I FURTHER AGREE TO ABIDE BY ALL THE LAWS OF THE COUNTRY I WILL BE VISITINGINCLUDING, BUT NOT LIMITED TO, REFRAINING FROM ANY USE OF ILLEGAL DRUGS. I REALIZE THAT ISV REQUIRES EACH PARTICIPANT TO HAVE HIS/HER OWN TRAVEL/MEDICAL INSURANCE WHICH WILL COVER THE PARTICIPANT WHILE IN THE COUNTRY OF TRAVEL AND AGREE TO SECURE SUCH INSURANCE PRIOR TO MY DEPARTURETO MY FOREIGN COUNTRY. I HAVE READ, UNDERSTAND, AND AGREE TO ABIDE BY ALL THE POLICIES STATED IN ISV'S TERMS & CONDITIONS (SEE COPY ON THE ISVWEBSITE UNDER "TERMS & CONDITIONS" AT WWW.ISVONLINE.COM)

Your Agreement*	Date*	INTERNATIONAL STUDENT VOLUNTEERS, INC.
Check this box to certify that you have read and properly filled out the correct information on this page.	[MM-DD-YY]	ADDRESS: 18032-C Lemon Drive, Yorba Linda, CA 92886 PHONE: (714) 779-7392 FAX: (714)777-4647 EMAIL: info@isvonline.com WEBSITE: www.isvonline.com