People of Peru Application/Information Sheet

Name exactly as it appears on your passport________________________________________ 
Passport Number (please write clearly)_____________________________________________           
Address_________________ City______________ State__________ Zip__________
Daytime Phone______________Evening Phone______________Cell_______________________

Email________________________   Gender: M  F   Date of Birth_______________              

Do you speak any languages other than English? No Yes-_________________________________
Previous service/mission trip experience?    No  Yes Where?_______________________________
What was your specific work that project?______________________________________________
What special skills do you have?______________________________________________________
Circle on (or more)  Student-What level?_____________  Professional-What area?______________
Retired-From what?___________________  Other-________________________________________
What area of service are you interested in?______________________________________________
Do you have any specific dietary needs?  No  Yes-_______________________________________
Do you have any non-typical physical limitations? No Yes-_________________________________
(People of Peru Project is happy to make accommodations for individuals with special needs we just need to know ahead of time what they are)

Please name two adult non relatives that we can contact for recommendation purposes.

1. ________________________________________Phone#    ______________________
2. ________________________________________Phone#    ______________________

I certify that everything in this application is correct.   I (we) wish to participate on this short-term service project and will uphold all guidelines and requirements set forth by the sponsoring organization.  I (we) also agree to the payment guidelines as stated herein.

Your Signature________________________                                                           Date__________