Mexico Service Project - Application - Youth Service International

Personal Information

Name*

First Last

Father's Name*

Mother's Name*

Address*

Street Address City State ZIP Code

Home Phone Number*

e.g. 123-456-7890

Cell Phone Number - Student*

e.g. 123-456-7890

Cell Phone Number - Parent*

e.g. 123-456-7890

Phone Number of Parent (emergency use only)*

e.g. 123-456-7890

Email Address - Student*

Email Address - Parent*

Date of Birth*

MM

DD

YYYY

Education

Name of School*

Year of High School Graduation*

Grade Point Average*

(eg. 3.8/4.0 or 92%)

Passport Information

Passport Name*

If you already have a passport, enter your name as printed in the passport. If you do not have a passport yet, enter your full name exactly as you will submit it in the passport application.

Visit travel.state.gov for instructions on getting a passport.

Passport Number

Passport Issuing Country

Passport Expiration Date

MM

DD

YYYY

Medical Information

Medical Insurance Company*

Medical Insurance Group Number*

Medical Insurance Policy Number*

Medical Insurance Phone Number*

Do you suffer from any allergies and/or health conditions?*

Click for YES
Click For NO

Please specify

Miscellaneous

Describe any personal, academic, athletic, travel-related or professional achievements that may be helpful to you as a volunteer.*

Foreign Language Skills*

Hobbies / Interests*

Work Experience*

Teaching Experience*

Essay*

Please write a short essay explaining why you want to participate in the Mexico Service Project. What aspect(s) of the program do you find most appealing? How do you expect to contribute to the success of the program?

You may want to draft your essay prior to completing the online application and then copy and paste it into the box provided.

Reference*

Who recommended this program to you?

Electronic Signature for Photo Release*

Parents must sign for applicants under 18 years of age.

I hereby authorize and consent to the use and reproduction by YSI staff or an authorized agent or assignee of any and all photographs taken of the above-named applicant for the purpose of promoting YSI programs, without any compensation to me. All film, together with any prints, shall constitute property of YSI, solely and completely.

Comments

Mexico Service Project – Application

Personal Information

Education

Passport Information

Medical Information

Miscellaneous