International Student Volunteers, Inc.

International Student Volunteers
High School Student Application

Full legal name that will appear on passport

Surname	First	Middle	Nickname

Number & Street (Current address)	Suburb	State/Territory	Postcode	Country

Number & Street (postal address)	Suburb	State/Territory	Postcode	Country

Mobile Phone	Email	Age	Gender
			Male Female

Home Phone	Alternate Email Address	Date of Birth

Country of Birth	Country of Residence	Citizenship

Emergency Contact 1	Relationship	Phone	Email Address

Emergency Contact 2	Relationship	Phone	Email Address

School Name	School Year	T-Shirt size
	9 10 11 12	S M L XL

Do you have any physical disabilities?	Yes No	Please Explain
Do you take any prescribed medications?	Yes No	Please List
Do you have any special dietary needs?	Yes No	Please List

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

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

HOST COUNTRY: In the spaces provided, number each country in order of preference ("1" is your first country preference). High school departure dates are listed below each country name.


Costa Rica	New Zealand	Thailand
2 Jan	2 Jan	2 Jan

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

Date school classes end for Term 4, 2011	Date school classes begin for Term 1, 2012

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

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

Do you speak Spanish? Yes No	If yes, how proficiently? Beginner Intermediate Advanced Fluent
Additional Interests:

I am interested in receiving information on how I can raise funds from the community to offset the cost of the ISV program


How did you find out about this program:
Teacher	Name:
Student	Name:
Announcement at my school
Newspaper/Magazine	Name:
Other	Please Describe:

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 VISITING INCLUDING, BUT NOT LIMITED TO, REFRAINING FROM ANY USE OF ILLEGAL DRUGS. I REALISE THAT ISV REQUIRES EACH PARTICIPANT TO HAVE HIS/HER OWN TRAVEL/MEDICAL INSURANCE WHICH WILL COVER THE PARTICIPANT WHILE IN THE COUNTRY OFTRAVEL AND AGREE TO SECURE SUCH INSURANCE PRIOR TO MY DEPARTURE TO MY ASSIGNED COUNTRY. I HAVE READ, UNDERSTAND AND AGREE TO ABIDE BY THE POLICIES STATED IN ISV'S WEBSITE (SEE THE ISV WEBSITE UNDER "TERMS AND CONDITIONS" AT www.isvonline.com/highschools).

Your Signature	Date

Parent/Guardian Signature	Date