1) Please complete and submit your application at least 60 days prior to your anticipated internship start date.
Applications may be submitted on line www.costaricainternships.com however we do require that an additional
signed application be submitted along with two letters of recommendation and your resume
2) Mail application materials to:
Costa Rica Internship Institute (CRINI)
P.O.Box 1171 C.P. 2050
San Pedro, San Jose, Costa Rica
3) Once we have reviewed your complete application, we will notify you of your acceptance to the program.
This usually takes 10 days upon receipt of all application materials. If you are accepted to the program,
we will send you an acceptance letter and program guide containing more detailed country, program and
project information. At this time we will also send you an invoice for the program deposit. We cannot begin
the formal placement process until we have received your $300 non-refundable deposit as guarantee of
your participation in the program.
COMPARATIVE HEALTH CARE PROGRAM COSTA RICA-NICARAGUA APPLICATION
Name: ______________________________________
Sex: Male/Female __________________________
Birthdate: _____ / _____ / _____
Passport No: _____________________________________
Expiration Date: ___________________________________
Street Address: _________________________________________________________
City: ________________________ State: _________ ZIP: _______________
Country: ________________________
Home Phone: ___________________ Cell Phone: _____________________
E-mail Address: ____________________________________________________________________
Current College or University (if applicable): ______________________________________
Major: _______________________________________________________
Current Employer and Occupation (if applicable) _________________________________
Internship start date: ____________________________
End date: _____________________________________
Total number of weeks: __________________________
Person to contact in case of emergency (name, telephone and email):
____________________________________________________________________
____________________________________________________________________
LANGUAGE
1) How many years of formal Spanish language training have you had? __________
Where and when? ______________________________________________________________
2) Have you ever studied/lived in a Spanish speaking country? ________________
Where and when? ______________________________________________________________
3) Other language spoken: ____________________________________________________
4) What is your current language level?
None ( ) Beginner ( ) Intermediate ( ) Advanced ( ) Fluent ( )
5) How comfortable are you with your Spanish skills?
Not comfortable _________ Somewhat comfortable ________ Very comfortable _______
Spanish is necessary for all health related internships
Will you need to enroll in Spanish Language classes (at an additional cost)?
Start date: ________________ End date: __________________
INTERNSHIP PLACEMENT
Please feel free to attach additional sheets if necessary.
Please state your reasons for wanting to participate in this program.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
What skills/past experience will you bring to your internship?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
What type of health care facility would you prefer to work (select no more than two)
Clinic ______________________
Medical teams that visit communities) _____
Children´s Nutrition Center ____________
School/facility for disabled people/youth/children ________________________
Hospital (primarily available in Nicaragua) _____________
Women´s health clinic ________________
Non-profit health care facility ___________
Retirement home: ______________________
Other (please specify) _______________________________
Why are you interested in working at one of these institutions/organizations?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Why do you feel you are qualified to work at one of these institutions /organizations (Remember: creativity,
motivations and interest are qualifications)?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Do you have any previous health care or medical experience (professional, academic or other internship)?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
In Costa Rica, would you prefer to work in an urban or rural area?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
In Nicaragua, would you prefer to work in Granada or in a rural setting?
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
HOUSING
Please state your housing preferences (for example a non-smoking household, a family with or without
small children, pets, etc.) ____________________________________________________________
Do you have any health problems that CRINI, Viva Nicaragua! or your host family should be aware of
(dietary restrictions, special medications, physical limitations or other special needs)?
If so please explain ________________________________________________________________
TERMS AND CONDITIONS
Application and Payment Process
After receiving your signed application, resume and letter of recommendation, we will begin the application
review process. Upon careful review of your application, we will notify you if you have been accepted.
This process usually takes one week to ten days.
Upon acceptance to the program you will receive an invoice for your $300 non refundable deposit.
We cannot begin the official placement process until we have received your deposit as guarantee
of your participation in the program.
Complete payment is due upon arrival. We accept personal checks and wire tranfers. Traveler checks,
credit cards, and money orders are NOT accepted.
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.
Intern Responsibilities and Expectations
- Interns who do not display appropriate behavior, fail to comply with the rules of the host organization or
that do not fulfil contracted work responsibilities will be dismissed without reimbursement of program fees
- Airfare to and from the United States is at the expense of the participant or his/her family.
- Participants agree to work the full amount of time which they have registered. No changes to program are
permitted one the program begun.
- Time off for travel during the contracted internship is not permitted.
I have read and I agree to all the above TERMS & CONDITIONS.
Signature: __________________________________
Date: _______________________________________
How did you hear about Viva Nicaragua! ? _____________________________________________
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