Service Trips/Internships Application

Service Trips and Internship Application

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Fields marked with an * are required

Once completing the following application please mail a $200 non-refundable deposit to:

Compas de Nicaragua, 60 Merrimack Road, Amherst, NH 03031, USA.

Application and deposit must be received at least one month prior to date of departure. Full non-refundable trip participaton fee is due two weeks prior to departure.

Please remember to scroll down to fill out entire application

First Name *

Last Name *

Address 1 *

Address 2

City *

Country *

Zip / Post Code *

Phone *

Email *

Gender *

Group affiliation (if any) *

Current occupation *

Trip Start Date (Month/Date/Year) *

Trip End Date (Month/Date/Year) *

Emergency Contact: First and last name *

Relationship

Address 1 *

City *

Country *

Zip / Post Code *

Phone *

Email *

Describe previous international travel experience *

What skills will you be able to contribute to this service trip? *

What would you like to gain from this experience? *

Please list any allergies, disabilities, or other health conditions: *

Do you have a history of drug and/or alcohol abuse? If yes, please explain: *

Are you currently under a physician's care or receiving prescribed medication? If yes, please explain: *

Additional information

I certify that the above information is truthful and accurate to the best of my knowledge: *