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 02-5640, Nica 867
Miami, FL 33102-5640
* * * * * * * * * * * * * * * *
» 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: _______________________________
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