Tilmelding * Enrolment * Inscription * COSTA RICA

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	COSTA RICA
	Please fill out in Spanish or English and press the "SUBMIT" button at the bottom of this page. For voluntary social work enrolments send a mail to info@exis.org with your CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.
Dato:
Nombre/First name:
Apellido/Last name:
Dirección/Address:
Country:
Téléfono/Telephone:
E-mail:
Nationality:
Occupation:
Formación/Education:
Edad/Age/Birth date:

Calificaciones/Special qualifications:

How long have you studied Spanish?	years months

Knowledge of other languages?	language years
	language years
	language years

When can you start?

Language course:	I would like to follow spanish lessons during
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks
	16 semenas weeks

Voluntary work:	Prefiero trabajar como voluntario con - I would like to work as a volunteer with:
	Programa A - trabajo social y otros trabajos voluntarios / social work and other voluntary work
	Programa B - parques nacionales / national parks

Program A:	Program A: Length of voluntary social work:
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks
	16 semenas weeks

Program A:	Para programa A, por favor, escoger tres de las posilidades singuientes según sus prioridades. In programme A, please select three of the following options according to your priorities.
	A1 Centro Educativo de Educación Prioritaria Itiquís
	A2 Patronato Nacional de la infancia Naranjo
	A3 Hogar Magdala
	A4 Escuela San Luis
	A5 Centro educativo Santo Domingo
	A6 Escuela Nacional de Rehabitacion
	A7 Hogar de Ancianos Santiago Carrillos
	A8 Hogar de Ancianos Santiago Crespo
	A9 Central Library of the National University
	A10 Escuela de Enseñanza Especial (Alajuela)
	A11 Centro Educativo San Gabriel
	A12 Hospital Nacional de Niños San José
	A13 Fundación Servio Flores Alajuela
	A14 Escuela Jesús Magdalena de Cacao

Program B:	Program B: Length of voluntary work in National Park
	4 semenas weeks
	6 semenas weeks
	8 semenas weeks
	12 semenas weeks
	16 semenas weeks

	Parque Nacional

Do you smoke?	yes
	no

Pårørende der bedes underrettet i tilfælde af sygdom o. lign. Who to contact in case of illness etc.

Apellido, nombre / Surname, first name

Dirección/Address

Téléfono/Telephone

E-mail:

Eventuelle bemærkninger: Comments:

Hvordan kom du i forbindelse med Exis? How did you find Exis?

		For voluntary social work enrolments please add a CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.