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(if part of address) |
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address
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| *Gender
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Female
Male
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*Age
or general age
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(this information helps us when matching roommates)
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| *Alumnus
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Institute
alumnus(a)
1st
time applicant
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I would like to participate in the following seminar(s): |
| Seminar 1: |
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| *Title
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| *Instructor
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| *Dates
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A few brief and thoughtful statements about yourself are an essential
part of your application. Please answer all questions frankly and
completely. Details are essential for planning purposes and are
appreciated both by the instructors and staff.
What are your specific interests, goals and expectations for the above
seminar(s)?
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Which of your experiences, classes, or interests are related to the above programs?
What is your current career or career interest and institutional affiliation?
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Are you fully able to participate in field trips, some of which may
involve hiking over rough terrain? Please indicate any concerns you
might have and how we might be able to help you. Information about field
trips for seminars is available (please inquire).
Have you ever travelled to South America, Central America, Mexico and/or
the Caribbean? Have any of your travels been to remote regions?
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What backpacking experiences have you had? Have any trips been for
extended periods of time? Can you sleep in a hammock? Can you swim?
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Do you have any special medical conditions, food allergies, or insect
allergies we should be aware of? Please be specific.
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Do you have any
special dietary requirements we should be aware of? How flexible or
fussy are you with regard to your diet and the water you drink? Meals
are prepared from foods that require no refrigeration and are
supplemented by fresh fish and or game, to the extent possible. If you
are a “vegetarian,” can you eat eggs, chicken, or fish?
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Do you have any personal habits, preferences, sensitivities, or concerns
you would like us to be aware of? Do you snore? How easy are you to get
along with?
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How well do you respond to unfamiliar situations, especially culturally
unfamiliar situations?
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How well do you understand and speak Spanish?
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Please select one of the following criteria if you Would you like to
apply for financial assistance discount (maximum 5%)?
Institute
alumnus(a)
University
student
Couple
Group
If you are a students, please list your college or university. If you
are an alumnus, please list seminars you have attended.
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Would you like to earn university credits? Graduate or undergraduate
credits? How many credits? from 1-2 credits are available for most
seminars. A special application form is available from the Institute
during the seminar. There is an application fee.
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Would you like to earn
4.5 continuing education units?
(=3.0 recertification credits)? A special application form is
available from the Institute. There is an
application fee.
Yes
No |
Other pertinent information, comments, questions, etc., are welcome!
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Purchase orders and training authorization forms may be faxed to
207-546-3042. Please make sure that your name and the seminar title are
listed on each form. Which of the following will you fax?
One combined purchase order for tuition, accommodations, and meals. One
invoice will be sent.
Individual purchase orders as needed for tuition, accommodations, and/or
meals. Matching invoices will be sent.
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Name and phone number in case of emergency:
I
understand that reasonable efforts will be made to assure my comfort and
safety while on this trip. I recognize my own responsibilities in this
regard. I am aware that there are risks inherent in travel to a foreign
country and to remote areas where I may be unfamiliar with the hazards
and where prompt medical care may not be available. I will sign up for
the travel insurance package required by the Institute. I agree that
Humboldt Field Research Institute is not responsible for any harm,
injury, loss, or damage I may suffer while participating on this field
trip. Full details on liability and the benefits of travel insurance are
available.
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