Name: *

Address: *
Example: 4202 E Fowler Ave., Tampa, FL 33620

Date of Birth: *
Example: 08/24/1987

Sex: Female Male *

Email: *

Phone Number: *
Example: 813-974-3180

Major / College: *
Example: Civil Engineering, College of Engineering

USF ID: *

Student Status: Freshman Sophomore Junior Senior Graduate Student Staff Faculty *

Ethnicity: African American Asian American Hispanic Latino Mexican American Multi Racial Caucasian Other *

T-Shirt Size: Small Medium Large X-Large XX-Large *

Are you a US Citizen? Yes No N/A *

If not, what is your country of citizenship?

Note: If not a US citizen, you may need to obtain a visa to Costa Rica.

Do you have a valid passport? Yes No *

Passport Number:
Valid Until:

Insurance Information

To participate on Alternative Spring Break with Volunteer USF, it is required to have health insurance. If you do not have health insurance, you can buy travelers insurance for around $30.

Which of the following applies to you:*

I have health insurance and I will provide my insurance information below.
I do not have health insurance, but if selected to participate in ASB for 2008, I will purchase travelers insurance for March 2008.

Insurance Company:

Policy #:

Emergency Contact Information

Name: *

Realtionship: *
Example: Father, Mother, Sibling, Gaurdian, etc.

Phone: *
Example: 813-974-3180

Short Responses

Since this application process is competitive, please take time to fill out the following short response questions.

Why should you be chosen to be a participant for International ASB?  Tell us things about yourself that make you stand out and how that will be of benefit to International ASB.
*

What previous volunteer experience do you have (also include specific experience with Volunteer USF, if any)?  Briefly explain.
*

Have you ever lived, traveled or studied in another country?  Explain briefly.
*

List any language proficiency, or prior language study.

ASB students are expected to meet with their team and site leaders on an on-going basis prior to the trip.  Please share your commitments for the upcoming year including other involvement, work etc. and how you will be able to be involved with ASB.  If there is a specific day/time that works best for meetings – please share that here.
*

How do you see this trip fitting into your future plans?
*

Is there anything else we should know about you?
*