Application for Tucker Foundation Nicaragua CCESP 2015

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PLEASE READ ALL INSTRUCTIONS CAREFULLY

Anticipated Trip Dates Dec. 1- Dec. 15, 2015

ALL APPLICANTS MUST COMPLETE the "General" section of this application, and IF APPLYING FOR SPECIFIC POSITIONS PLEASE COMPLETE ALL APPLICABLE SECTIONS (Student Director, Officers or Translator).

Example 1: If applying for the Student Director position, Clinical Health Officer, and Translator – you would need to complete the "General", "Student Director", "Officer", and "Translator" sections of the application.

Example 2: If applying as a general participant and for a "Translator" position, you would need to complete the "General", and "Translator" sections of the application.

Student Director and Officer Applications Due Fri. March 7 @ 11:59 p.m.
General Participant Applications Due Wednesday April 9 @ 11:59 p.m.
Late applications may not be considered

Student ID *

Name *

Class *

Prefer to go by

Major/Minor (NA if not applicable yet) *

Telephone/Mobile

Blitz *

There is a possibility that a for-credit course related to the themes of CCESP will be offered in Fall '14 through LALACS. Would you be available and interested in taking this course in a 3A course slot? *

This would be instead of a student organzied seminar series Fall term.

YES

Please mark which information session you attended

Info sessions are mandatory for all applicants, unless you were off-campus, or were on the CCESP trip previously.

D-Plan *

Check the box if you will be on campus during the term indicated.

X'14

F'14

W'15

S'15

Required

Are you applying for the Student Director position *

Gender *

Female

Male

Transgender (Male-to-Female)

Transgender (Female-to-Male)

Other

I Choose Not to Identify

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