ISV - 2009 UK Application

< ISV - 2009 UK Application

INTERNATIONAL STUDENT VOLUNTEERS, INC
UK APPLICATION

*required fields

Full legal name that will appear on passport

First Name *	Middle Name	Last Name *	Nickname

Current Street Address *	City *	County*	Postcode*	Country *

Permanent Street Address	City	County	Postcode	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
		Undergrad 2nd Year 3rd Year 4th Year 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 or 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 Programme. 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 28 May 11 June 25 June	9 July 23 July 06 Aug	15 May 29 May 12 June 26 June	10 July 24 July 07 Aug 21 Aug	15 May 29 May 12 June 26 June	10 July 24 July 07 Aug 21 Aug	15 May 29 May 12 June 26 June	10 July 24 July
		Winter Dates		Winter Dates
		Nov 2009 Dec 2009	Jan 2010 (Dates TBD)	Nov 2009	Jan 2010 (Dates TBD)

Ecuador		New Zealand		South Africa		Thailand
15 May 29 May 12 June 26 June	10 July 24 July 07 Aug 21 Aug	14 May 28 May 11 June 25 June	9 July 23 July 06 Aug	14 May 11 June	16 July 13 Aug	14 May 28 May 11 June 25 June	9 July 23 July 06 Aug 20 Aug
		Winter Dates				Winter Dates
		Jan 2010 (Dates TBD)				Nov 2009 Dec 2009	Jan 2010 (Dates TBD)

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

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

How did you find out about the ISV programme? (Please check all that apply and explain.)
Classroom Announcement	Name of Announcer?
Professor / Teacher	Name of Professor?
Past Participant / Student Rep	What was their name?
A Friend or Family member	What was their name?
Flyer / Poster	Where did you see it?
Email Announcement / Newsletter
Social Network	Please explain: (MySpace, Facebook, YouTube, other)
Internet / Website / Search	Please explain: (Website URL, Keywords, Search Engine, etc.)
Other	Please explain:

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 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 DEPARTURE TO MY FOREIGN COUNTRY. I HAVE READ, UNDERSTAND, AND AGREE TO ABIDE BY ALL THE POLICIES STATED IN ISV'S TERMS & CONDITIONS.

Your Signature *	Date	INTERNATIONAL STUDENT VOLUNTEERS, INC.
		ADDRESS:	Unit 214, Buspace Studios, Conlan Street, London W10 5AP
		PHONE:	020 8206 6021
		FAX:	020 8964 9244
		EMAIL:	isvuk@isvonline.com
		WEBSITE:	www.isvonline.org