ISV - 2009 Canadian Application

INTERNATIONAL STUDENT VOLUNTEERS, INC
CANADIAN PARTICIPANT APPLICATION

*required fields

Full legal name that will appear on passport

First Name *	Middle Name	Last Name*	Nickname

Current Street Address *	City *	State *	Zip *	Country *

Permanent Street Address	City	State	Zip	Country

Primary Phone Number *	Primary E-mail Address*	Age *	Gender
			Male Female

Secondary Phone Number	Alternate E-mail Address	Date of Birth *

Country of Birth	Country of Residence	Citizenship *

Emergency Contact 1 *	Relationship *	Phone *	E-mail Address

Emergency Contact 2	Relationship	Phone	Email Address

University *	University Major	School Year
		Freshman Sophmore Junior Senior Graduate Student Not a Student

Do you have any physical disabilities? Please Explain	Yes No
Do you have any allergies? Please List	Yes No
Have you been hospitalized in the last 12 months? Please Explain	Yes No
Do you take any prescribed medications? Please list name and what it is for	Yes No
Do you have any special dietary needs? Please List	Yes No
Are you a returning ISV participant? If yes, what country & year?	Yes No
Do you speak Spanish? Yes No	If yes, 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, Eastern Europe, South Africa, and Thailand
I would like to participate in a social community development project.
Costa Rica, Dominican Republic, Ecuador, Eastern Europe, South Africa, and Thailand.

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

HOST COUNTRY: Number each country in order of 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.

AUSTRALIA		COSTA RICA		Dominican Republic		Eastern Europe
14 May 21 May 28 May 04 June 11 June 18 June 25 June 02 July	9 July 16 July 23 July 30 July 06 Aug 13 Aug 20 Aug	15 May 22 May 29 May 05 June 12 June 19 June 26 June 03 July	10 July 17 July 24 July 31 July 07 Aug 14 Aug 21 Aug	15 May 22 May 29 May 05 June 12 June 19 June 26 June 03 July	10 July 17 July 24 July 31 July 07 Aug 14 Aug 21 Aug	15 May 22 May 29 May 05 June 12 June 19 June 26 June 03 July	10 July 17 July 24 July 31 July 07 Aug 14 Aug 21 Aug
		Winter Dates		Winter Dates
		20 Nov 08 04 Dec 08 01 Jan 09 15 Jan 09	Nov 2009 Dec 2009 Jan 2010 (Dates TBD)	20 Nov 08 15 Jan 09	Nov 2009 Jan 2010 (Dates TBD)

Ecuador		New Zealand		South Africa	Thailand
15 May 22 May 29 May 05 June 12 June 19 June 26 June 03 July	10 July 17 July 24 July 31 July 07 Aug 14 Aug 21 Aug	14 May 21 May 28 May 04 June 11 June 18 June 25 June 02 July	9 July 16 July 23 July 30 July 06 Aug 13 Aug 20 Aug	14 May 11 June 16 July	14 May 21 May 28 May 04 June 11 June 18 June 25 June 02 July	9 July 16 July 23 July 30 July 06 Aug 13 Aug 20 Aug
		Winter Dates			Winter Dates
		11 Jan 09	Jan 2010 (Dates TBD)		20 Nov 08 04 Dec 08 01 Jan 09 15 Jan 09	Nov 2009 Dec 2009 Jan 2010 (Dates TBD)

Why would you be a suitable participant on ISV's programs?

Date university classes end for summer (if applicable)	Date university classes begin in fall (if applicable)

Hobbies/interests: (Please list activities/interests you enjoy most)

Travel experience: (Please list all foreign countries to which you have traveled)

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 or Peru 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.

How did you find out about the ISV summer program?
			Classroom Announcement- name:	Friend:
E-mail	Flyer/Poster	Myspace/Facebook	Past Partcipant/Student Rep- name:	Other:

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.ORG)

Your Signature *	Date	INTERNATIONAL STUDENT VOLUNTEERS, INC.
		ADDRESS:4848 Lakeview Ave., Suite 100A, Yorba Linda, CA 92886 PHONE: (714) 779-7392 FAX: (714)777-4647 EMAIL: info@isvonline.com WEBSITE: www.isvonline.org