Teachers Immersion Registration FormWe’re excited to have you on our upcoming Spanish Immersion program!Please complete your trip registration. If you have any questions or trouble completing this registration form, please contact us.Spanish for Teachers Immersion Application2023 Educators Immersion Registration Please fill out this registration form in its entirety and submit. Your information may or may not be saved on this page if you navigate away.Tell us how you heard about this program?*Do you remember if you were searching online... some sort of advertisement... social Media... a presentation, a friend?Select Your Immersion ProgramWhich Spanish for Educators Immersion Program are you applying for?*Programs technically begin on Monday morning at 8am. However, we usually have activities scheduled for the Sunday prior, including an orientation and walk around town. 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!1wk Ecuador 6/17-6/241 wk Ecuador 6/24-7/11 wk Costa Rica 7/1- 7/81 wk Costa Rica 7/8- 7/152 wk Ecuador 6/17- 7/12 wk Costa Rica 7/1 - 7/152wk Costa Rica 7/8 - 7/222wk Ecuador & Costa Rica 6/24 - 7/83wk Costa Rica 7/1 - 7/223wk Costa Rica 7/8- 7/293wk Ecuador & Costa Rica 6/17-7/83wk Ecuador & Costa Rica 6/24-7/154wk Costa Rica 7/1- 7/294wk Ecuador & Costa Rica 6/17- 7/154wk Ecuador & Costa Rica 6/24-7/225wk Ecuador & Costa Rica 6/17 -7/225wk Ecuador & Costa Rica 6/24 - 7/296wk Ecuador & Costa Rica 6/17 - 7/29Do 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...Personal InformationName* First Last Grade level / Subject Area* Employer / School where you currently teach* 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*Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Will any children, family members or special friends accompany you?* Yes No Please list each of the family members traveling with you:First & Last NameGenderDate of BirthPassport number & ExpirationAllergies (Food & other)Medical Conditions Emergency Contact InformationFull Name* Relation to Participant*Email* Cell Phone*Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Passport InformationName Exactly as on Passport First Last Passport NumberYou absolutely need a passport to travel, 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.Date of IssuePlease enter this date as it is on your passport: Month, Day, Year MM DD YYYYDate of ExpirationPlease enter this date as it is on your passport: Month, Day, Year MM DD YYYYIs your passport issued by the United States of America? Yes No What country has issued your passport?Medical InformationPrimary Care Provider*Phone Number*Medical Insurance Carrier*Policy Number*Health Conditions*List any health conditions (physical, mental, etc.) 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.Medications*Please list any medications / vitamins you are taking. This information is kept extremely confidential, but is useful in case of emergency.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 No COVID - Underlying ConditionsPlease list any underlying conditions you have that may complicate your health if you were to contract COVID 19 while abroad.AllergiesPlease list any and all allergies to food, insects, medications, etcSpecial Dietary NeedsPlease list all special food requirements you require.Host Family InformationWould you like a special recommendation for Hotel or Hostel Lodging?*Our standard program includes host family lodging and 2 meals/day. 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 No 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? Dietary, physical, other?*Do you smoke?*Spanish Language ExperienceBriefly Describe your Spanish experience*Please include number of years of Spanish in high school, college, or any related foreign travel, etc.Are you able to comfortably communicate in the present tense in Spanish? Sí No, ayúdame Are you able to comfortably communicate in the past tense in Spanish? Sí No, ayúdame Are you able to comfortably communicate using commands in Spanish? Sí No, ayúdame Are you able to comfortably communicate using the subjunctive in Spanish? Sí No, ayúdame Speaking Proficiency*BeginningIntermediateAdvancedNear NativeOral Comprehension*BeginningIntermediateAdvancedNear NativeReading Comprehension*BeginningIntermediateAdvancedNear NativeWriting Ability*BeginningIntermediateAdvancedNear NativePlease explain why you wish to participate in this program and what you hope to gain from it.*Are you interested in receiving CEU credits OR graduate level credits for this Spanish immersion program?. Yes No Payment InformationIs your school or employer paying for this immersion program?* Yes No Employer / School contact name that will be handling payment*Employer / School Contact Email Address* Employer / School Contact Phone*Δ
Pauline Katz May 7, 2022 at 8:31 amPretty psyched to meet all of you and live and learn in another culture for a while. Reply
JILL WHITMIRE March 13, 2022 at 5:57 pmI am beyond excited! It is my first time traveling out of the U.S., and I’m excited to meet new friends and learn Spanish to help me communicate with the families of my students! Reply
Bennae Dillingham February 21, 2022 at 10:17 amI can’t wait for the trip. I am SUPER excited to take on this new adventure! Reply
Pretty psyched to meet all of you and live and learn in another culture for a while.
I am beyond excited! It is my first time traveling out of the U.S., and I’m excited to meet new friends and learn Spanish to help me communicate with the families of my students!
I can’t wait for the trip. I am SUPER excited to take on this new adventure!
I’m so happy to be apart of this!
I am super excited!