Perú Service Project - Application - Youth Service International

Full Passport Name

If you already have a passport, enter your name exactly as it is printed on the passport. If you do not yet have a passport, enter your full name exactly as you will submit in the application to request your passport. If you do not have a middle name or initial, leave it blank.

First Name*

Middle Name or Initial

Last Name*

Personal Information

Father's Name*

Mother's Name*

Street Address*

City*

State*

ZIP*

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*

Please note: Both the student and parent email addresses will receive confirmation of your completed application after you click 'Submit' below. Both will also be used for all communication regarding the Peru Service Project: Announcements regarding acceptance or rejection to the program, deadlines, required travel forms, flight information, etc.

Date of Birth*

MM

DD

YYYY

Education

Name of School*

Year in School (Fall 2015)*

Grade Point Average*

(eg. 3.8/4.0 or 92%)

Miscellaneous

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

Foreign Language Skills*

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

Click for YES
Click For NO

Please specify

Hobbies / Interests*

Work Experience*

Teaching Experience*

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.

Reference*

Who recommended this program to you?

Comments

Essay*

Please write a short essay explaining why you want to participate in the Summer 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.