BOLIVIA CULTURA VOLUNTEER PROGRAM APPLICATION

PERSONAL INFORMATION
Name: Last Name:
E-mail:
Home Address:
City: State:
Country: Postal code:
Home Phone: Office Phone: Fax:
Gender: Female!ale
"ate of #irth:
Nationality: Pass$ort: %
EMERGENCY CONTACT INFORMATION
Name:
&elation to you: 'ele$hone:
Address
City StatePro(ince )i$$ostal code
E-mail
PROGRAM DATES
Start:************ End: ***************
Ho+ did you hear a,out -olunteer #oli(ia. /nternet Flyer Friend other
MEDICAL INFORMATION
"o you ha(e any medical $ro,lems includin0 aller0ies or heart $ro,lems affected ,y hi0h altitude
that limit your a,ilities. 1esNo
Please ex$lain:
****************************************************************
HOUSING
"o you +ant to li(e +ith a family. 1esNo

/f no $lease s$ecify your housin0 needs:
***************************************************************
"o you ha(e any dietary restrictions 2(e0etarian3. 1esNo
Please ex$lain:****************************************************
LANGUAGE CLASSES
Le(el of S$anish: #e0inner**** /ntermediate***** Ad(anced**** Fluent******
Comments:
Other lan0ua0es s$o4en:
Other S$anish courses ta4en 2$lease list3:
5ee4s of classes desired********************************
2Note: -olunteer #oli(ia stron0ly su00ests that (olunteers ta4e a minimum of one month of classes63
VOLUNTEER POSITION
5hat ty$e of (olunteer +or4 are you interested in. 5hat s4ills or a,ilities do you ,rin0 to the
(olunteer $osition. 5hat moti(ates you to +ant to come to #oli(ia and (olunteer. 5hat are your
$re(ious (olunteer ex$eriences. Please include any other information you feel is $ertinent to your
a$$lication6
Note: 'he more detail you 0i(e us the ,etter +e can $lace you6
PAYMENT POLICY
$ All fees need to ,e $aid in full u$on arri(al 2no exce$tions36
$ Payment can ,e made in cash7 ,y $ersonal che8ue or credit card 296:; surchar0e36
$ All $ayments must ,e made in <S "ollars or #oli(ianos6
$ #oli(ia Cultura reser(es the ri0ht to determine refunds on a case ,y case ,asis6 'he de$osit is
non-refunda,le6
$ /f a $artici$ant +ishes to defer $artici$ation to a future date7 the de$osit may ,e a$$lied
#oli(ia Cultura re8uires a =us >?? de$osit to reser(e your s$ot in our $ro0ram6 'his should ,e $aid
once you are acce$ted into the $ro0ram and is non refunda,le6 'his can ,e in the form of a chec4
made out to BOLIVIA CULTURA and sent ,y certified mail to: Casilla 2411, Co!a"a#"a,
Boli$ia, So%&! A#'(ia