| First Name: |
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| Last Name: |
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| Preferred First Name: |
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| Gender: |
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| Citizenship: |
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| Address: |
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| City: |
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| State or Province: |
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| Zip or Postal Code: |
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| Country: |
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| Phone: |
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| Email: |
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| Date of Birth (MM/DD/YYYY): |
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| How did you hear about ProWorld |
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| Golden Key Honour Society Member? |
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PROGRAM SELECTION
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Select the country and program of interest for your Internship Abroad.
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| Country: |
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| Intern Abroad Dates: |
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| Intern Start Month: |
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| Intern Start Year: |
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| Intern Number of weeks: |
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| Optional Spanish Classes (Additional $585 / week in Peru, $490 / week in Mexico) |
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| Enroll me in additional Intensive Spanish Classes |
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| Number of weeks of class and any notes |
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| ACADEMIC CREDIT |
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| Are you seeking credit for your internship? |
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| If yes, what are the requirements? |
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| PROJECT PREFERENCES |
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| Select the desired focus for your internship by numbering your top 3 project preferences. |
| Based on your interests and skills, and the needs of the community, we will create the appropriate project placement. |
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| Engineering/Building: |
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| Education/Teaching: |
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| Environment: |
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| Health Care: |
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| Journalism: |
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| Micro Business: |
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| Technology: |
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| Women's Rights: |
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| Community Development: |
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| Any Valuable Project: |
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| Other project (specify): |
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| Program and Project Selection Notes: |
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| EDUCATIONAL BACKGROUND |
| College or University: |
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| GPA: |
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| Program Major: |
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| University Standing: |
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| Foreign Language, Years of study, Notes: |
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| Foreign Language fluency, please rate: |
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| PERSONAL EXPERIENCE |
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| Please rate your experience level on a scale of 1 - 10 and provide a brief note about each one. |
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| SHORT ANSWER QUESTIONS |
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| Interests and skills related to your project preferences |
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| List certifications (CPR, teaching, etc): |
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| What skills do you hope to gain with ProWorld? |
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| Any other information to help us prepare your program: |
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| HOUSING QUESTIONS |
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| I like living with children: |
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I like living with pets:
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| Specific dietary restrictions: |
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| Any other details regarding housing? |
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| EMERGENCY CONTACT DETAILS |
| Emergency Contact Name: |
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| Relationship: |
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| Emergency Contact Address: |
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| Emergency Contact Telephone: |
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| Emergency Contact Email: |
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