International Student Volunteers, Inc.

Classroom announcement

Name of announcer

Other Description

ISV Past Participant

Name of friend

International Student Volunteers
NEW ZEALAND PARTICIPANT APPLICATION
Please use your full legal name that will appear on passport


Surname		First		Middle		Nickname


Number & Street (current address)	Suburb City	Postcode	Country


Number & Street (mailing/permanent)	Suburb City	Postcode	Country

			Male	Female
Mobile Phone	Email	Age


Home Phone	Alternate Email	Date of Birth


Country of Birth	Country of Residence	Citizenship


Emergency Contact Name 1		Relationship		Mobile Phone		Email Address


Emergency Contact Name 2		Relationship		Mobile Phone		Email Address

			1st year			3rd year	Graduate Student
University (if applicable)		Course of Study (if applicable)	2nd year			4th year
				T-shirts Size:	S M L XL

Do you have any physical disabilities?	Yes	No
Do you take any prescribed medications?	Yes	No
Do you have any special dietary needs?	Yes	No
Do you have any allergies?	Yes	No
Are you a returning ISV participant? (If yes, what country & Year?)	Yes	No

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 (New Zealand, Costa Rica, Thailand)

I would like to participate in a community development project (Costa Rica, Dominican Rep, Thailand)

I am willing to do anything and have no project preference.

Please state the full name of any friend you would like to be placed with, as well as the name of the University
they attend. (if applicable)

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 in each program during November 2008 to February 2009. Remember, the more flexible you are the easier it will be for ISV to reserve a place for you.


Costa Rica*	Thailand	Dominican Republic	New Zealand
20 Nov	20 Nov	20 Nov	12 Jan
04 Dec	04 Dec	15 Jan
01 Jan	01 Jan
15 Jan	15 Jan

* Note: Participants travelling to Costa Rica and taking the Spanish language course will depart 6 days earlier than listed above.

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

	Date university classes end for second semester		Date university classes begin for first semester

	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

If yes, how proficiently?

Beginner

Intermediate

Advanced

Fluent

	How did you find out about the ISV Summer Program?
	Flyer	E-mail	Website

I am interested in the 5-day Spanish language lessons (Costa Rica participants only)

		I am interested in the possibility of earning Academic Credit (for details, click here. Note: Students are responsible for determining in advance the transferability of units to their home institutions. There will be an additional cost for Academic Credit)

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

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 OF TRAVEL AND AGREE TO SECURE SUCH INSURANCE PRIOR TO MY DEPARTURE TO MY FOREIGN COUNTRY. I HAVE READ, UNDERSTAND AND AGREE TO ABIDE BY ALL THE POLICIES STATED IN ISV'S WEBSITE (SEE THE ISV WEBSITE UNDER "TERMS AND CONDITIONS" AT www.isvonline.com)


	Your Signature		Date

				INTERNATIONAL STUDENT VOLUNTEERS PTY LTD. PO Box 137 145 Parnell, Auckland 1151 New Zealand Phone: (09) 521 2522 Email: isvnz@isvonline.com Web: www.isvonline.com