Volunteer Nicaragua
Internships - Spanish - Experiential Learning Programs in Nicaraguahttp://www.nicaraguainternships.com
Short-Term
Volunteer Program
Application
Application Instructions:HOME

1) Copy & paste ENTIRE UNEDITED TEXT of this form into a Word Document.
2) Double-click on the blank lines to complete each question
3) E-mail your application to apply@nicaraguainternships.org
4) Print and sign a copy to send to Viva Nicaragua!
5) Once we have received and reviewed your application, we will send you
a confirmation letter and invoice for your $200 non-refundable deposit.
6 ) After receiving your deposit and reviewing your application,
we will send you acceptance and placement notification along with
important volunteer and country information.
7) Mail the signed copy of your application to:
Viva Nicaragua!
P.O. Box #210
Granada, Nicaragua
Central America

* * * * * * * * * * * * * * * *

» SHORT TERM VOLUNTEER PROGRAM APPLICATION

GENERAL INFORMATION

Name: ____________________________________________________

Sex: Male/Female __________________________

Birthdate: _____ / _____ / _____

Passport No: _____________________________________

Expiration Date: ___________________________________

Street Address: _________________________________________________

City: ______________________ State: _________ ZIP: _______________

Country: ________________________

Home Phone: _______________ Cell Phone: __________________

E-mail Address: __________________________

Volunteer start date: ____________________________

End date: _____________________________________

Total number of weeks: __________________________

Emergency contact (name & telephone):

____________________________________________________________________

 

VOLUNTEER PLACEMENT
Describe your reasons for participating in this program.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

What areas are you most interested in working in? (check all that apply)

Environmental brigades _________

Schools _________

Adolescents ________

Children ________

Orphanages ________

Sports ________

Disabled people ________

Tutoring ________

English ________

Art/Dance/Music ________

Housing projects ________

Garden projects ________

Other ________

List any special experience or skills that you will bring to this program.

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

 

LANGUAGE

1) How many years of formal Spanish language training have you had? _________

Where and when? _________________________________________

2) What is your current language level?

None ( ) Beginner ( ) Intermediate ( ) Advanced ( ) Fluent ( )

3)How comfortable are you with your Spanish skills?

Not comfortable ________ Somewhat comfortable ________ Very comfortable ________

Would you like to enroll in Spanish language classes (at an additional cost)? Yes ( ) No ( )

Start date: ____________ End date: __________

HOUSING
Please check your housing preference.

With family ________

In hotel (not available in all areas) ________

In hostel (not available in all areas) ________

For family stays:
Please list any allergies and/or dietary restrictions (be specific):

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Special requests
____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

AIRPORT PICK-UP

Arrival Date: __________ Arrival Time (AM or PM?): __________

Airline: ________ Flight #: ___________

 

TERMS AND CONDITIONS

Application and Payment Process

Upon receipt of your signed application and non-refundable deposit, we will send
a confirmation letter along with important country and program information.

Complete payment is due on your program start date.

There will be no refunds after the program has begun. In the event of a personal emergency,
we will review the situation and may issue a partial refund.

Volunteer Responsibilities and Expectations

• Volunteers who do not display appropriate behavior will be dismissed without reimbursement
of program fees. The return travel is at the expense of the participant or his/her family.
• Participants agree to work the full amount of time for which they have registered. No changes
to program are permitted once the program has begun.

I have read and I agree to all the above TERMS & CONDITIONS.

Signature: __________________________________

Date:_______________________________________

WAIVER OF LIABILITY

All volunteer are required to be insured. It is recommended that interns purchase
an international student id card and/or international traveler’s insurance.

Viva Nicaragua! is not responsible for any medical bills accrued during the Volunteer Program.

There are inherent risks to participating in this program which include but are not limited
to accident,illness, or natural disasters. By signing below you assume all possible risks and
agree to waive Viva Nicaragua! from all liability.

Signature: ___________________________

Date: _______________________________

How did you hear about Viva Nicaragua! ? _____________________________________________

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