Request edit access
About you and your preferences
Please fill out all information
* Required
Email address
*
Your email
Peru....What an adventure!
Full Name
*
Your answer
Current Address
*
Your answer
Mobile number used for WhatsApp
*
Your answer
Are you coming with a group?
*
Yes
No
If yes, with which group are you affiliated?
Your answer
If you have a preferred roommate(s), please include below.
Your answer
Would you like to request a private room? (Private room cost is an additional $50 for each night)
*
Yes
No
To better match you with a roommate, what is your preferred sleeping schedule? (Remember, campaigns have early departures, sometimes prior to 6 am)
Go to bed between 8 and 9 pm
Go to bed between 9 and 10:30 pm
Go to bed between 10:30 pm and midnight
Go to bed after midnight
prefer not to say
Birth Date
*
MM
/
DD
/
YYYY
Do you have any known allergies? If yes, please describe.
*
Your answer
What medications do you currently take?
*
Your answer
What is your level of Spanish proficiency?
*
Choose
Basic 1--No Spanish at all
Basic 2--Can introduce yourself and can ask and answer questions about personal details
Basic 3--Can communicate in simple and routine tasks
Intermediate 1--Can deal with most situations that could arise while traveling if alone
Intermediate 2--Can interact with a degree of fluency and spontaneity that makes regular interaction with native speakers quite possible without strain for either party.
Advanced 1--Can express yourself fluently and spontaneously without much obvious searching for expressions.
Advanced 2--Can express yourself spontaneously, very fluently and precisely, differentiating finer shades of meaning even in more complex situations.
Native speaker
What is your NPI number, if applicable?
Your answer
Have you traveled internationally before?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
Forms
