Purdue Timmy Global HealthEcuador Medical Service Trip ApplicationMarch 10-18, 2012 (Saturday to Saturday)Application due date: Friday, September 30thCost: ~$1,800 all inclusive*****Please include a picture of yourself in an attachment***** with the application!Name:Local Address:Local Telephone #:Home Address:Home Telephone #:Email Address:Date of Birth: Year at Purdue:School: Major: GPA:Please rate your Spanish speaking/comprehension ability. No prior Spanish knowledge or classis required for the trip. (circle one) No experience Minimal Moderate Excellent FluentPlease list and briefly explain the volunteer and extracurricular experiences you have had sofar at Purdue University (if a freshman, list activities in high school).188.8.131.52.5.6.Please state how you learned about Purdue Timmy Global Health (circle one).
BGR Advisor E-mail FlyerFriend Activities Fair Other:______________Please list any past involvement with Timmy Global Health.How does this short term Medical Service Trip fit into your long – term goals?Describe a cultural experience you have had. How did it change your perspective? How iscultural understanding helpful in medicine?
What can we do here at home to help improve healthcare in overseas communities?As a requirement for this year’s trip, each individual going on the trip will have to commit tothree donation-days (Saturday or Sunday) in the Fall 2011 and Spring 2012 semesters. Duringdonation days, Timmy Global Health members gather at local grocery stores and pharmaciesand collect donations of valuable items that are taken to Ecuador with the group.Will you be available to commit your time for three donation days? (circle one) Yes No Maybe (If answered maybe, please explain.)*****Please include a picture of yourself in an attachment***** with the application!Please email completed forms to Hannah Burgess at email@example.com. For more information,please email Hannah, or visit http://www.timmyfoundation.org and http://purdue.edu/timmy. (ListTimmy Foundation in the subject header).Ten minute Interviews will be held October 6th & 7th between 6pm-9pm in BRNG 1238.Please rank (1-2) the days you are available. Wednesday, October 6th ____ Thursday, October 7th _________Mandatory Payment and Trip Meeting schedule for trip-goers:Mid October: First payment due to IndianapolisMid November: Second payment due to Indianapolis, and deposit becomes non-refundable.Early January: Final payment due to IndianapolisMandatory Trip Meetings: 8:00-9:00 pm. Every other Thursday starting early November.TBA: 3 Donation Days to collect supplies for EcuadorTBA: Donation drop off day at TF Warehouse in Indianapolis (all inventories turned in)TBA: Packing party at TF warehouse in Indianapolis