Tropical Pathology and Infectious Disease AssociationTM

“Humanitarian Service with a Human ExperienceTM”

Our Mission

The Tropical Pathology and Infectious Disease Association (TPaIDATM) is a private, educational organization designed to educate students in the basic science, diagnosis, and treatment of infectious tropical diseases while providing medical assistance to other countries.

TPaIDATM Application for Medical internship/Study Abroad

2009/10

To apply for the medical internship, and study abroad through the Tropical Pathology and Infectious Disease AssociationTM (TPaIDATM), please fill out the application/questionnaire attached.

If applying for travel, please include a mandatory $75.00 processing fee with your application.

Tuition: For the winter quarter of 2009 and for the year of 2009/2010, tuition is $2,575.00. Please note that 10% of the tuition fee will be nonrefundable along with the $75.00 application fee. In addition, tuition fees are subject to change. For more information please contact TPaIDATM, Inc., at the address and phone number provided below. Travel and study in Cuzco is also available. Tuition can be paid at www.Tpida.org.

For additional information about study abroad, contact TPaIDATM at:

TPaIDATM, Inc.

8256 garnet canyon Lane

Las Vegas, Nevada 89129

1-702-371-6440

APPLICATION FORM

School ______

Title (Mr. Ms. Dr., etc) ____

Last Name, First Name ______

Date of Birth (must be 18) ______

City ______

State, ZIP ______

E-mail ______

Telephone(s) ______

Degree (B.S., professional, other) or major:

I wish to (check all that apply):

___ Become a Member of TPaIDATM ($50.00)

___ Travel to Peru in 2009-10

___ Request additional information

Number the travel dates you are interested in, in order of preference, dates may change by a day or two to accommodate travel:

___ December 13-21, 2009

___ January 11-22, 2010

___ March 14-22, 2010

___ May 30-June 8, 2010

___ July 11-19, 2010

___ August 1-9, 2010

___ August 15-23, 2010

___ December 13-21, 2010


Additional Information (required):

Scrub Size

Top: Sm____ Med____ Large____ XLarge____ XXLarge____

Bottom: Sm____ Med____ Large____ XLarge____ XXLarge____

Please check all that apply:

Educational Level

___ Current Undergraduate, graduation year: ______

___ Current Graduate student

___ Bachelor’s degree – Date completed: ______

___ Other: ______

List any college biology, medical related, chemistry, or other science courses you have taken, or will complete by the time you plan to travel (you need only list a few):

I am applying for travel to Peru for:

___ Professional development

___ Continuing education

___ Humanitarian purposes

___ Help in applying to professional schools

___ Self-interest

___ Other, please describe: ______

Do you have a current passport? Yes ___ No ___

Will you allow TPaIDATM to contact you for a follow up questionnaire one year after travel?

Will you allow TPaIDATM to maintain your contact information?


Please Read the following before continuing:

TPaIDATM is a private, educational organization designed to educate students in the basic science, diagnosis, and treatment of infectious tropical diseases, as well as, providing medical assistance to other countries.

Submitting an application for travel does not guarantee a seat in a class traveling to Peru. TPaIDATM screens all applicants for acceptance. Applicants must be at least 18 years old, be in good health, and able to travel internationally. Preference will be given to students who have completed one year of study in biology or the health sciences. After all applications have been screened, you will be notified of acceptance to TPaIDATM.

You must provide proof of vaccination to TPaIDATM. Once you have been accepted for study, you will be sent a list of required vaccinations.

Important Health Information: What medical problem do you have?

You cannot travel with TPaIDATM if you are:

·  Immunocompromised

·  Pregnant or plan on becoming pregnant prior to travel

Please sign here: Date: ______

Send Application to:

TPaIDATM, Inc.

8256 Garnet Canyon Lane

Las Vegas, Nevada, 89129

1-702-371-6440

Please write a one page essay stating why you would like to travel to Peru and what you hope to gain by going (required for application):

1