International Internships and Volunteer Network: Program Application

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Int’l Internship & Volunteer Network

“Enriched Career Experiences Abroad”

Program Application

* Required fields
Name *
E-mail Address *
Birthdate: *
Country of Citizenship: *
Do you currently possess a Passport? *	Yes No
If you do not have a Passport, have you already applied for one? *	Yes No N/A - Already have a Passport
Country of Passport Issue: *
Passport Number: *
Passport Expiration Date (if available): (Must be valid for at least 6 months following program end date.)
Mailing Address *
Physical Address *
Home Phone *
Cell Phone *
Other Phone
Gender *	Male Female
What languages do you speak, read & write, and what is your level in each (beginner, intermediate, advanced)? *
First Country & Program Preferred *
Second Country & Program Preferred (Optional) *
Third Country & Program Preferred (Optional) *
Preferred Occupational Category *
Desired Length of Program *
Preferred Start Date (A non-refundable Rush Charge of $250 USD will be applied to programs starting 45 days or less from date of “Acceptance Letter”.)
Preferred End Date *
Describe your perfect placement, including size and type of host employer preferred, experience/exposure you are wishing to obtain and any other special requirements that must be taken into consideration for your program (i.e..dietary, religious, allergy/medical or other personal factors which a host employer should be made aware of to ensure a comfortable work environment.). *
Name & Address of Educational Institution Attending(ded) *
Phone Number of Educational Institution Attending(ded) *
Graduation Date *
Degree(s) Obtained *
Emergency Contact Name *
Emergency Contact Address *
Emergency Contact E-Mail *
Emergency Contact Home Phone *
Emergency Contact Cell Phone *
Have you ever been charged or convicted, or are you under criminal investigation for offences against the law in any country? If yes, please forward details along with submission of this application. (Note: any pending charges or convictions may delay the processing of a visa and/or the Embassy may refuse to grant you a visa).	Yes No
How did you hear about the Int'l Internship & Volunteer Network? *
If you were referred to our program, who referred you? *
Will you be traveling with a companion(s) during your program? If so, please provide the individual(s) name and contact information so that we may follow up to ensure placement arrangements are handled appropriately. *
Notes/Comments:
1. DECLARATION: I have familiarized myself with the IIVN Application Process and understand that all required documents must be submitted prior to moving forward (www.IIVNetwork.com/ApplicationProcess.html). I have clarified any questions I have with regard to the process, am capable of reading and understanding this process in English and understand this process applies to me and my program. *	Yes No
2. DECLARATION: I have read, understand and agree to abide by all IIVN program policies, guidelines and timelines, and I understand all apply to me and my program participation.: *	Yes No
3. DECLARATION: I understand that the IIVN APPLICATION FEE ($250 USD) must be submitted, along with the Participant Agreement, within five (5) calendar days following date of Acceptance Letter, and confirms my serious intent to secure an opportunity with IIVN. No action will be taken to further process a Program Application until this fee is confirmed. I understand the Application Fee is NON-REFUNDABLE and will be deducted from Total Program Fee due. IIVN Cancellation Policy applies.: *	Yes No
4. DECLARATION: I have familiarized myself with the IIVN Program Fee and Inclusions of the program I am interested in experiencing; www.IIVNetwork.com/ProgramFees.html. I am capable of reading and understanding the Program Fee/Inclusions in English. *	Yes No
5. DECLARATION: I understand that the IIVN PROGRAM FEE (less Application Fee) must be submitted within ten (10) calendar days following submission of Application Fee and confirms my participation in an IIVN program. No action will be taken to further process my application until receipt of the Program Fee is confirmed. The Program Fee is subject to IIVN Cancellation Policy.: *	Yes No
6. DECLARATION: I understand that failure to submit the required Application Fee, Program Fee and Participant Agreement within the time frames noted, will result in forfeiture of my program participation. IIVN Cancellation Policy will apply. *	Yes No
7. DECLARATION: I understand that the processing time to secure a suitable placement varies and IIVN guarantees a confirmed placement prior to my scheduled start date. Should IIVN be unable to confirm a placement prior to this date, 100% of monies submitted will be refunded per IIVN Cancellation Policy. *	Yes No
8. DECLARATION: In the event I decide to purchase an airline ticket to the host country prior to a placement, or receipt of all required legal travel/work/visa documents being confirmed, I will be personally responsible for any and all charges that may be incurred in the event travel arrangements need to be changed. I understand I must provide a copy of my travel itinerary to IIVN and that the carrier resources provided by IIVN are only options for consideration. *	Yes No
9. DECLARATION: I understand I am personally responsible for confirming and securing all necessary legal work/travel/visa documents to participate in an IIVN program. I know of no reason why I would be refused a visa or other legal documents for the country I am visiting. In the event I fail to secure the necessary legal work/travel/visa documents prior to departure, I understand that I am personally responsible for any resulting consequence at my own expense. IIVN Cancellation Policy applies: *	Yes No
10. DECLARATION: Participant agrees to pay all fees in full to IIVN no later than 45 days prior to the start date of their respective program, in accordance with the guidelines set out in the Application Process and Program Fee Payment Plan. *	Yes No
11. DECLARATION: I understand that the Int'l Internship & Volunteer Network reserves the right to reject any applicant/application which is deemed not to be in the best interests of the respective program. *	Yes No
12. DECLARATION: I understand that a RUSH CHARGE of $250 USD will be applied to programs starting 45 days or less from date of Acceptance Letter. This Rush Charge is over and above the noted Program Fee and is NON-REFUNDABLE. IIVN Cancellation Policy applies.: *	Yes No
13. DECLARATION: Unless otherwise noted, I understand all Professional Internship & Pre-Med Programs are unpaid, professional placements. Participation in these programs is reserved for mature, independent individuals, who are prepared to financially support themselves throughout the duration of their program. *	Yes No
14. DECLARATION: I have read and understand the IIVN Cancellation Policy (www.IIVNetwork.com/CancellationPolicy.html) and have had the opportunity to ask questions and obtain advice as to its meaning. I understand this policy is legal and binding and will apply to my program participation. I am capable of reading and understanding the policy in English. I do not rely on any promises, statement or representations that are not expressly stated in this Policy.: *	Yes No
15. DECLARATION: I declare that ALL information provided in my IIVN Program Application is true to the best of my knowledge and I understand that any false or misleading information may lead to immediate dismissal from an IIVN Program. *	Yes No
16. If you are interested in one of our Payment Plan options, please indicate your preference. A description of each option may be found at www.IIVNetwork.com/PaymentOptions.html. *	Standard Payment Plan Preferred Option A - Two Installments Option B - Three Installments Option C - Four Installments
17. DECLARATION: In the event I have elected to take advantage of one of the Payment Plan options offered by IIVN, I acknowledge my understanding of and agreement to comply in full with all terms of the plan I selected. I confirm I am capable of reading and understanding the respective plan guidelines in English. *	N/A - I prefer to take advantage of the Standard Payment Plan. Yes No
Today's Date: *

I have read and agree to the Privacy Policy *

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