Online Application

Personal Information

First Name (as it is on your passport)
Last Name (as it is on your passport)
Email	Please list only one, valid email address!
Birth Date (MM/DD/YYYY)
Language Level	See How to Rate Your Language Level

Address
City
USA State / Canadian Province
State/Province (Outside N. America)
Postal Code
Country
If the above address is temporary (College Campus, etc.) enter your permanent address below.
Alternate Address
City
USA State / Canadian Province
State/Province (Outside N. America)
Postal Code
Country

Home Phone
Work Phone
Cell Phone
Fax

Sex	Female Male
Occupation
Employer or School Attending
Nationality
Passport Number	(If not available, provide ASAP)
Emergency Contact
Emergency Phone
Languages You Speak
List the name(s) of any especially helpful AmeriSpan staff member(s)
How you heard about us

Program Type

Calendar Year in which
you wish to study

Type of Program

Language School
Volunteer & Intern
College Study Abroad
Teenager Summer Abroad
Group Program

SALUD Medical Spanish or Portuguese
Business & Professional Programs
Programs for Educators & Teachers
Language & Fun

Language School Program Options

Select Country
Program Location
Course Description
Course Special Notes
Number of Weeks

Business & Professional Program Options

Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks

Programs for Educators Options

Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks

Language & Fun Program Options

Select Country
Program Name
Course Description
Course Special Notes
Number of Weeks

Volunteer/Internship Placement Options

Placement Type
Select Country
Placement First Choice
Placement Second Choice
Placement Third Choice
Placement Comments
# of Weeks of Language Class:	If not taking classes enter 0 (zero)
Placement Length (Weeks):
Health/Physical	Do you have any health related or physical conditions that would limit where you could be placed? If yes, please explain.
Volunteer/Internship Essay Question	You can do your essay questions now (recommended) but if you prefer, you can download this word document and complete your answers later and email, fax or upload them. Part 1: Language Proficiency (if the target language is different from your own) ------------------------------------------------------ Answer as many of these questions in the target language as possible (regardless of your level) to the best of your ability without using a dictionary or grammar book. Each question is directed to you in the 3rd person polite you form. 1. What type of activities do you like to do? 2. What is your best friend like? 3. What did you do last weekend? 4. What did you do last year? 5. You are talking with a person that is going to travel to your country for the first time. What would you advise him/her? Part 2: For all programs ------------------------------------------------------ 1. Explain your reasons for wanting to participate in this program. Why do you think you are a good candidate for it? 2. Please describe the type of work you would most enjoy for the placement category you have listed on the application (for this category only). If you chose: a. Environment/Nature: Please describe your interests: Volunteering/interning with animals (if so, what types), at a garden or farm, in an agricultural cooperative within the local community, etc.; b. Educational, ESL teacher and/or Social Work: Please explain what populations you would like to work with (the elderly, infants, teenagers, disabled, etc) and in what type of setting (school, orphanage, community center, etc.); c. Healthcare placement: Please list your medical certification/area of expertise. d. Other categories: Please list your interests and preferences (marketing, tourism, museums, libraries, government, etc). 3. What are your expectations for the placement (the work, the environment, etc.)? 4. Do you have any health-related or physical conditions that would limit where you could be placed? If yes, please explain. Part 3: For Full-time Volunteer and Volunteer Only ------------------------------------------------------ 5. What research have you done on the geographical area? Are you going to be able to work in this climate and in these conditions? 6. Explain how you would apply some of your current skills to your description(s) of work in question 3 above. 7. List three challenges (besides language) you expect to encounter in your work environment. How would you resolve resolve them? 8. Please describe any travel experience you have had in developing countries and if you experienced culture shock. If you have not traveled in developing countries, please describe culture shock and how you think you would handle it. 9. How flexible are you about where you are placed? Our placements include non-profit, for-profit, NGO's, local, national and international/governmental organizations, etc. Would you work in any of the above? What are your placement requirements? 10. How much supervision do you expect to receive at your placement? 11. Do you realize that volunteer work may be full-time (some times including nights and/or weekends) and can be very difficult and at times boring? Part 4: For Internships ------------------------------------------------------ 1. Please write a motivation letter of 1-2 pages (if possible in the target language) explaining why you want to do an Internship, your goals for the experience, and what you could contribute to the organization. 2. A copy of your college transcripts is required for most professional placements in Europe and Australia.

SALUD Medical Spanish Program Options

Country	s
Program Name

Type of Studies	Undergrad Grad MD RN DDS Other:
Med School Years Finished by Program Start
Specialty/Particular Interest
State your Expectations	(ex. improve medical vocabulary, learn about another culture, etc.)
What previous experience, if any, do you have with LEP (Limited English Proficiency) patients? Were you effective in communicating with them and understanding them? Explain.

College Study Abroad Program Options

Program

Course Listings
Language Course(s)
Elective Course(s)
Current School/University
Year in School
Cumulative Grade Point Average (on a 4.0 scale)

Arrival Information

Do you want an airport pick-up No Yes

Airport Pickup
If you wish an airport pick-up and you know your flight details, you may provide it now. In general, we recommend that you wait for AmeriSpan to confirm your program prior to purchasing a non-refundable airline ticket. You may submit your application without this information.


Airport Pickup Cost	(See pricing table above)
Airport Pickup Airline
Airport Pickup Flight Number
Airport Pickup Date	(MM/DD/YYYY)
Airport Pickup Time

No Pick-up but AmeriSpan is Arranging Lodging
If you will be staying in lodging arranged by AmeriSpan, we need an estimated time (a 2-3 hour window) when you will be arriving to that lodging so you will be expected. You may provide this information at a later date.

Arrival Time

Price Information

Registration Fee	(Do not include $ sign)
Program Cost	(Do not include $ sign)
Late Fee	(Do not include $ sign)
Other Costs (not listed above)	Describe: (Do not include $ sign)
Total Deduction/Discount	Code: (Do not include $ sign)
Total Price	(Do not include $ sign)

Miscellaneous Information

Academic credit is not available for all programs.
Will receive Credit from Brookhaven College
Will receive Credit from
Other Program Options or comments

Terms & Conditions

I have read and agree to the terms and conditions.


	Email: info@amerispan.com
	Business Hours: 8am-2pm EST (Mon-Thu), 7am-1pm EST (Fri)

	Worldwide: Worldwide: +(34) 91 591 23 06

We offer programs in the following countries:

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Online Application

If the above address is temporary (College Campus, etc.) enter your permanent address below.

Teenager and High School Programs

Group Programs

Teenager and High School Programs

Group Programs