First Name:
Last Name:
Email Address:
Date of Birth: (mm/dd/yyyy)
Primary Phone Number:
Address:
City:
State:
Zip Code:
Country of Residence:
Country of Citizenship:
Do you have a valid Passport?	Yes No
University Attending/ Attended
Field of Study / Intended Major
Date of Graduation
What dates would you like to volunteer with us?
What is your Spanish skill level? (Spanish is not required for this program so please answer honestly)	Fluent Pretty Good Average Very Basic No Experience
Are you applying as:	An Individual With Friends
If you are applying with friends, please list their first and last names below.
Why are you interested in participating in this program? (500 words or less)
What do you hope to learn and achieve on from this Volunteer Experience? (500 words or less)
Please describe your relevant skills, interests, or experience that you bring to this program. (1000 words or less)
Is this your first experience traveling to a foreign country?	Yes No
Please tell us why you are interested in the South American Andes. (500 words or less)
Please indicate which subject area you are most interested in learning about on this trip.	Poverty and Related Social Issues Education / Illiteracy Abuse & Family Issues Public Infrastructure & Architecture Environmental Conservation OTHER
If you answered other, please indicate your interest below
Please list any medical conditions you have:
Please list any medications you are currently taking or will be taking during this trip.
Please List any Allergies you have: (answer "none" if this doesn't apply to you)
Please list any dietary restrictions you have: (answer "none" if this doesn't apply to you)