CINCO Language & Internship Program

SAS Internship Program, Dominican Republic.

SAS Internship Program – Dominican Republic

Tel: (829) 875-4599/ (719) 387-8036, Fax (480) 247-4411
Email:

Program Application

PERSONAL INFORMATION

Name (as it appears on your passport):

Preferred First Name:

Email address:

Mailing address:

City/State/Zip:

Country:

Permanent address (if different from above):

Phone: H

Date of Birth: Gender: M( ) F( )

Country of Citizenship:

Current occupation:

Have you ever been convicted of a felony? ( ) Yes ( ) No If yes, please explain.

PROGRAM INFORMATION

Approximate Program start date:

Desired Program length (in months): ______

Do you have a valid passport? Y ( ) N ( ) Passport #:

Have you been to the Dominican Republic before? Y ( ) N ( )

If yes, please indicate the nature of your travel:

Please list countries of previous international travel and the type of travel (tourist/volunteer/educational, etc.):

Level of fluency in Spanish: None Poor Good Fluent

No. Years of Spanish Study:
Where:

Please list any other languages that you speak, not including English or Spanish:

How did you first hear about us?

Do you have any dietary restrictions we should know about? If yes, please explain:

EMERGENCY CONTACT INFORMATION

Name: Relationship:

Address:

Day Phone:
Evening Phone:

Do you have life insurance? Y ( ) N ( )

CURRENT AND PAST EXPERIENCE

Prior Volunteer or Internship Experience:

Employment History: Please attach a resume / Curriculum Vitae. Please include a Spanish version if available.

Education: Name of Institution Year Graduated Field(s) of Study / Major

Name of Institution. ______.

Year Graduated. ______.

Field(s) of Study / Major. ______.

**Please attach copies of your college/university diploma(s) and / or transcripts. **

Please describe any other formal, or informal, educational experiences that may be relevant:

______.

Special Skills (i.e. computers, technical, trade, etc)

______.

Areas of Interest: (List in order of priority, 1 top priority, 5 lowest)

Possible Placements Desired: (List organizations/companies by type)

Application Fee: $ 70

For faster processing pay the application fee using PAYPAL o Banc Transfer, the easy, free and secure way of purchasing items on the web.

Do you wish you wish to use this service to pay for the application fee? ( ) YES** ( ) NO

**An invoice will be sent to you via e-mail upon receipt of this application.

I have reviewed the above information, and it is true and complete to the best of my knowledge. (This application cannot be processed without your signature.

Date:______
Signature:______

Attachments:

( ) Resume / Curriculum Vitae (English)

( ) Resume / Curriculum Vitae (Spanish)

( ) Copies of college diploma and/or transcripts

( ) Statement of Interest (optional)

Mailing Address:

Severino Polanco, Director
SAS Internship Program
Tel: (829) 875-4599/ (719) 387-8036, Fax toll Free (888) 845-3110
Email: