Chile Application Questionnaire
Name: ______Passport Number:______
Please complete this questionnaire and upload it to your participant portal. Your answers will help us to make the best possible placement for you. We will do our best to create a program which will meet your expectations, but please remember that we cannot guarantee the program will meet all of your expectations.
Placement
1) What type of project would you like to do?
2) What is your motivation for this type of project?
3) What are your goals for the program?
4) What are you expectations of the program?
5) What background do you have (ie academic, professional) that will allow you succeed in this placement?
General
1) Living abroad can be a challenging experience. What qualities do you have to adjust to a different culture and new living/working environment?
2)What does culture shock mean to you? Have you ever experienced it, and if so, please explain how you handled it.
3) Please list your prior international travel experience. Include dates (MM/YYYY- MM/YYYY).
4) Do you have any health conditions we should be aware of?
5) Please list any medical treatments you are undergoing, including prescription medications
Spanish Language
Please rate your level of Spanish knowledge
Speaking SkillsWriting SkillsListening Skills
O Non-ExistentO Non-ExistentO Non-Existent
O BeginnerO BeginnerO Beginner
O High-BeginnerO High-BeginnerO High-Beginner
O Low-IntermediateO Low-IntermediateO Low-Intermediate
O IntermediateO IntermediateO Intermediate
O High-IntermediateO High-IntermediateO High-Intermediate
O AwesomeO AwesomeO Awesome
ELI can arrange for Spanish classes while you are in Chile. Placement tests and classes begin the first Monday of each month. Classes take place on a weekly basis (Monday-Friday), and include 30 hours of instruction. The classes cost an additional $190/week for group classes and anywhere from $200-$310/week for private lessons. You may take classes at the start of your program, or you may take classes at the same time as your placement. If you take classes alongside your placement, you will spend approximately 4-5 hours at your placement.*Prices may vary, please ask for details.
Would you like to take Spanish classes?
O No thanks.
O Yes please.
If yes, for how many weeks? _____
Housing
Participants in this program may stay with a local host family or in a shared apartment with Chilean Roommates and other international volunteers or interns.
Which housing option do you prefer?
O Host Family
O No Meals
O Half Board (Breakfast and Dinner) for additional cost
O Shared Apartment
Do you have any allergies that might affect your housing placement?
O No
O Yes
If yes, please explain:
Do you have any “pet” issues?
O No
O Yes
If yes, please explain
Do you prefer to live in a smoking or non smoking environment?
O Smoking
O Non-Smoking
O No preference
How do you describe yourself? (i.e. independent, shy, outgoing, private, geeky, stubborn, awesome, etc.)
What are you interested in? What activities do you enjoy? (i.e. music, sports, reading, etc.)