Builders of Hope Tijuana BC Mexico May 31- June 6, 2015

A week long direct service project
to the poor of Mexico
House Building
with Esperanza International

http://tinyurl.com/mexicoapp

Application

First Name *

Last Name *

Student ID# (write "not student" if not from LIU POST) *

Cell Phone *

YOUR Email Address *

Name of Emergency Contact

Emergency Contact Phone Number *

Relationship to you:(mother, father,..etc.) It can not be someone on the trip. *

Emergency Contact Email Address *

Your Home Address *

Your City *

Your State *

Zip *

Your Gender *

Male

Female

Passport Information (You need a valid passport to re-enter into the United States)
Check "I have a passport" if you have a passport that will be valid on May 1, 2013

You will need to get one and show Fr. Ted or Jeanette by April.
If you are an international student you will need
   a. The Travel I-20 Recently signed
   b. Your first I-20 with the STAMP on it.
   b. You will need to investigate if you need a Visa and get one if necessary. *

I have valid Passport

I need to get a Passport (It takes about 6 weeks to get a passport)

References and Experience (for 1st time Volunteers Only)

List a reference (work or professor)

(Work or Academic) Reference's Email Address

List a reference (a friend)

Friends's Reference's Email Address

List a reference (clergy, club advisor, coach) (not Father Ted)

Clergy, Advisor or Coach's Email Address (not Fr. Ted)

Write a short paragraph as to why you wish to do this project:

What skills or talents do you have that would be helpful to this experience? (EMT, Play an Instrument, Sing, prior construction work)

Write a short paragaph about other volunteer work you have done.

Permissions, Waivers and Health Information

I agree to abide by the LIUPost Code of Conduct. *

Yes

I have the following health issues: (write none if you have none) *

I have the following allergies *

Your health insurance must cover international travel.

I realize there will be secondary insurance purchased for me. *

Yes, but will turn in my own insurance informaion.

Health Insurance Company *

Health Insurance Account Number *

Payment Options

Your space is not secure unless you have paid. Although you have reserved online, you are not confirmed until there is payment. Spots are only held for 48 hours with out money. This is only refundable until April 1. All funds are non refundable after that date.

I understand that my fees are non refundable after April 1 *

Yes

I am:

a returning volunteer

a first time volunteer

I will pay by:

I will pay cash or credit card at the chapel

I will pay online