Costa Rica Trip Application: March

15th-23rd, 2012 Columbia University Global Health

Personal Information

______________________________________________________________________ First Name Last Name Date

______________________________________________________________________ School/Year of Graduation Major Gender

______________________________________________________________________ Phone number UNI Preferred E-mail

______________________________________________________________________ Dorm Lerner Mailbox

Questions

Be Thorough With Your Answers!

1) How did you hear about the Global Health Service Trip?

2) Have you traveled outside the U.S? If so, where?

3) What is your level of Spanish? Have you taken any courses in Spanish? (Previous Knowledge Not Required)

Fluent

Completed Req.

Still taking courses

No familiarity

4) Previous medical-related volunteer experience? Have you volunteered in a hospital or clinical setting?

5) Do you have any volunteer experience abroad? If so what sort of experiences?

6) Are you involved on campus? If so which groups? Do you hold leadership positions?

7) Are you involved in CU global health? If so do you hold a position?

8) Why do you want to go on our service trip?

9) Choose 2 words to describe your personality: 1. 2.

Send to cuglobal.health@gmail.com as a PDF by November 18th!