Travel Registration: Medical Immersion & Int'l Rotation

You are going to LOVE this trip!

Notes about this medical Spanish immersion & international rotation travel registration:

Have your passport*, medical insurance, and emergency contact information handy to complete this program registration.
If, for some reason you have not made your $500 non-refundable program deposit yet, please make that deposit now (this deposit applies to your immersion program fee). Your space on the program is not reserved until you make your deposit.
Once you’ve completed this registration and your initial deposit, you will receive access to our online pre-departure course with tons of necessary information about your trip, a few travel contracts to sign, and a payment schedule for the balance of your program.

*You absolutely need a passport for travel to Ecuador & Costa Rica. Passport fields are not “Required” fields on this registration form, so you will still be able to submit your registration even if you don’t have a valid passport currently.

If you have any questions or need special arrangements, contact us!

2024 Medical Spanish Immersion & International Rotation Registration Form

2025 Medical Spanish Immersion Registration

No problem if you can’t fill out this registration form all at once. On the bottom of this form, you can see an option to “Save and Continue Later”. Go ahead and get started!

"*" indicates required fields

Select Your Immersion Program

Which medical Spanish immersion program are you registering for?*

Programs technically begin on Monday morning at 8am. However, we usually have activities scheduled for the Sunday prior. We suggest you arrive in country on the Saturday before the program begins. If you’re arriving while the program is already underway, consider arriving on the Friday before so that you can join us on a weekend excursion!

What is your Tshirt size?

Please select your size. These are standard unisex T-Shirts… and they fit pretty true to size.

XXL

Do you anticipate needing flexible start/end dates? OR – Have you pre-arranged custom trip dates?

We’re happy to work with you on your start/end dates within reason; let us know what you need! If you’ve pre-arranged custom dates with CGI, please specify here…

How did you hear about this program?*

Do you remember if you were searching online… some sort of advertisement… social Media… a presentation?

Personal Information

Name*

First Last

Profession/Area of Study*

Home Phone*

Cell Phone*

Email*

Please provide an email address that you check regularly. Program updates and documents will come to you primarily via this email address.

Gender Identity

Please add your preferred pronouns here as well

Date of Birth*

Month

Day

Year

Address*

Street Address City State ZIP Code

Will any children, family members or special friends accompany you?*

Yes

Please list each of the family members traveling with you:

First & Last Name

Sex

Date of Birth

Passport # & Expiration Date

Allergies (Food & Other)

Emergency Contact Information

Full Name*

Relation to Student*

Email*

Cell Phone*

Address*

Street Address City State ZIP Code

Passport Information

Name Exactly as on Passport

Passport Number

You absolutely need a passport to travel in and out of Costa Rica, however this section is not required to fill out your application in case you don’t have one yet or it needs to be renewed. Please fill out this information if you have a valid passport.

Was your passport issued by the United States of America

Yes

From which country was your passport issued?

Date of Issue

Please enter this date as it is on your passport: Day, Month, Year

YYYY

Date of Expiration

Please enter this date as it is on your passport: Day, Month, Year

YYYY

Medical Information

Primary Care Provider*

Phone Number*

Medical Insurance Carrier*

Policy Number*

Health Conditions & Medications

List any health conditions (physical, mental, etc.) and medications that we should know of. Conditions exacerbated by stress and fatigue would be particularly important to include. This information is kept strictly confidential; please include everything that will help us keep you safe and healthy while traveling abroad.

Have you completed the COVID – 19 Vaccination?*

Please select “yes” if 100% done, “No” if not at all, & “Other” and provide detail if you’ve not completed your vaccination regimen.

Yes

Other

COVID – Underlying Conditions

Please list any underlying conditions you have that may complicate your health if you were to contract COVID 19 while abroad.

Allergies

Please list any and all allergies to food, insects, medications, etc

Special Dietary Needs

Please list all special food requirements that student has.

Host Family Information

Would you like a special recommendation for Hotel or Hostel Lodging?*

Our standard program includes host family lodging and 2 meals/day in CR.

However, some travelers are uncomfortable with that. Please let us know if you plan to opt-out of host family lodging. This will require special hotel or hostel recommendations that we’re glad to provide, but you’ll take care of paying directly to the hotel or hostel.

Yes

Are you a smoker?*

Yes

Do you prefer a family with or without children?*

With Children

Without Children

Doesn’t matter

Do you need any special accommodations at your host family?*

Would you like your own host family or share with another participant (in different rooms)?

Please note that depending on the country and availability you might have to share host families with another participant and you will each have your own private rooms.

I prefer not to share

I’m flexible and could share

Spanish Language Experience

Oral Comprehension*

Speaking Proficiency*

Reading Comprehension*

Writing Ability*

Briefly Describe your Spanish experience*

Please include number of years of Spanish in high school, college, or any related foreign travel, etc.

Statement of Purpose / Interest in Immersion Program

Please explain why you wish to participate in this program and what you hope to gain from it.*

Travel Registration: Medical Spanish Immersion & International Rotations