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First name:

Last name:

Gender:

Email Address:

Date of birth:

MM DD AAAA

Permament address:

City:

State:

Zip Code:

Country:

Cell Phone Number:

How did you know about AMAPERUWORLD? Write the name of the person who recommended you this program :

College – University:

College – City:

Current / previous college enrolled:

We welcome all applicants. If you are not a student or have not attended university, please list highest education acquired

College :

Freshmen
Sophomore
Junior
Senior
Graduate Student
Other

Graduation Year (or projected):

Major(s):

GPA:

Which dates are you interested in attending?

SESSION I-2012- TRUJILLO : December 17 - January 6, 2013 (3 weeks)
SESSION II-2013 - TRUJILLO : February 8 - March 15 (5 weeks)
SESSION III-2013 - TRUJILLO : March 17 - April 20 (5 weeks)
SESSION IV-2013 - TRUJILLO : April 22 - May 24 (5 weeks)
SESSION V-2013 - TRUJILLO : May 25 - June 28 (5 weeks)
SESSION VI-2013 - TRUJILLO : June 30 - August 3 (5 weeks)
SESSION VI-2013 - CUSCO : June 30 - August 3 (5 weeks)
FULL SESSION - TRUJILLO : May 25, 2013-August 3, 2013 (10 weeks)
SESSION VII-2013 - TRUJILLO : August 5 - September 8 (5 weeks)
SESSION VIII-2013 - TRUJILLO : September 10 - October 14 (5 weeks)
SESSION IX-2013 - TRUJILLO : October 16 - November 19 (5 weeks)
SESSION X-2013 - TRUJILLO : November 21 - December 17 (4 weeks)

Which program(s) are you interested in? (List up to three choices in order of preference.)

Clinical Life:	1 2
Teaching English:	1 2

Describe your educational background and if you had any work experience:

Describe any volunteer or intercultural experiences you have had:

Do you have any previous traveling experience?

Do you speak any other languages? Please list them and note how well you can speak( minimal, conversational, adept or fluent). Include any coursework taken and whetever you have ever worked in a relevant foreign language environment:

Please prepare a brief personal statement addressing the following questions (500-1000 words):

How will this experience relate to your personal and career goals?
• What sets you apart from other program applicants? What can you offer to the communities we serve?
• Ama Perú volunteers come into very close contact with the Peruvian culture and way of life both at their homestays and at their work sites that may make them uncomfortable at first.
Describe how you would react to an uncomfortable situation to make the experience positive for yourself and fellow volunteers?

EMERGENCY CONTACT INFORMATION:

Full name:

Phone number:

Emergency contact relashionship:

Do you have any allergies or food restraints? Please list them here

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