PERSONAL INFORMATION
Full Name (exactly as appears in your passport)
First Name
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Middle
Last Name
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Suffix
Gender
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Male
Female
Date of Birth
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- - Choose One - -
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
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- - Choose One - -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Email
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I am a:
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Freshman
Sophomore
Junior
Senior
Do you have a valid
US
passport?
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Yes
No
If no, please explain:
Is it valid through 6/1/2011?
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Yes
No
If no, please explain:
EXPERIENCE
Have you travelled to Latin America before?
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Yes
No
If so, where and in what capacity?
Have you travelled to a developing country before?
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Yes
No
If so, where and in what capacity?
How many years have you studied Spanish?
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Reading Fluency
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Novice
Advanced Beginner
Intermediate
Advanced
Fluent
Native
Writing Fluency
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Novice
Advanced Beginner
Intermediate
Advanced
Fluent
Native
Speaking Fluency
*
Novice
Advanced Beginner
Intermediate
Advanced
Fluent
Native
Other languages spoken?
Please list your volunteer service experience
Q&A
Are you willing to contribute or fundraise (as a group or individually) the cost of this trip (approximately $1,050 p/p all inclusive)?
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Yes
No
Race/Ethnicity (BECA is committed to diversity. Providing this information is optional, but the information will assist us in furthering our commitment to diversity.)
American Indian
Asian
Black/African American
Hispanic or Latino
White/Caucasian
Other
Would you feel comfortable staying in a modest Honduran homestay for a week? (You would be paired with another trip participant).
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Yes
No
Do you have any emotional or physical limitations?
What skills (first aid, construction, photography, etc.) or interests (globalization, L.A. politics) do you have that might pertain to this trip? List them briefly:
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What are your primary reasons for participating on this trip (500 words or less)?
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I understand that participation on this trip is voluntary and that neither the trip nor BECA is affiliated with Davidson College. I also understand that if selected, I will be responsible for paying or fundraising the full trip amount by a date to be determined in advance of the trip. I further understand that parental permission may be required for this trip.
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Yes, I agree.
No, I do not agree.
By placing your Electronic Signature on this form and by submitting this application, you certify that all of the information is true and correct.
Electronic Signature:
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*