Membership Application Membership Application Thank you for applying to become a member of CU Peru. The submission deadline is September 30th, 2016 at 9 P.M. Please consider saving your work in a different document. Step 1 of 3 33% Name* First Last Email* Occupation or current graduate school program*Expected Graduation Year20152016201720182019202020212022Before your current program did you pursue any other advanced degrees?Undergraduate Program - Degree(s)/Date(s)?*As an organization that focuses its energy in the Peruvian Amazon, it’s important that our members experience the work we do on-site. Our on-site work occurs during the summer months (June and July) as well as winter (Dec-Jan). Are you interested in the January training, the summer training, or both?*JanuarySummerBothNeitherHow many weeks do you think can you commit this coming January (preferably 2-4 weeks)?*1 week2 weeks3 weeks4 weeks> 4 weeksHow many weeks do you think can you commit this coming summer (preferably 3-8 weeks)?*< 3 weeks3 - 4 weeks4 - 5 weeks> 5 weeksIf you are unable to travel to Peru this year, what do you envision your role in the organization being?*How long do you foresee yourself staying committed/involved in CU Peru?*How did you hear about CUPeru?Please select your level of Spanish from the following guidelines:*Native/functionally native: I converse easily and accurately in all types of situations. Native speakers, including the highly educated, may think that I am a native speaker, too.Advanced: I speak very accurately, and I understand other speakers very accurately. Native speakers have no problem understanding me, but they probably perceive that I am not a native speaker.Good: I speak well enough to participate in most conversations. Native speakers notice some errors in my speech or my understanding, but my errors rarely cause misunderstanding. I have some difficulty communicating necessary health concepts.Fair: I speak and understand well enough to have extended conversations about current events, work, family, or personal life. Native speakers notice many errors in my speech or my understanding. I have difficulty communicating about healthcare concepts.Basic: I speak the language imperfectly and only to a limited degree and in limited situations. I have difficulty in or understanding extended conversations. I am unable to understand or communicate most healthcare concepts.Describe your Spanish background (coursework, living in Spanish speaking countries):*Are you currently enrolled in/planning to enroll in Spanish courses this fall/winter/spring? If so, where?* Experience: Please elaborate on relevant experiences below. Feel free to leave any sections blank, we do not expect anyone to have experience in every area.Tell us about any Global Health experience you have. (Please include dates, locations, time spent abroad and projects if applicable.)What work experience do you have?What experience do you have working with non-profits? What specifically did you do?Do you have any experience with teaching (please specify age range and language taught in)? Do you have any experience with fundraising? Do you have any experience with grant writing? Do you have any experience in graphic design? Do you have any experience in marketing? Do you have any experience with human subjects research, educational research, program evaluation, or organizational quality improvement?Tell us about a job, organization, or project in which you have taken a on a leadership role: About you: You will be spending a lot of time in very close quarters. We want know more about you as a person.The Peruvian Amazon can be a very different experience for those who are unfamiliar. You will be dirty, itchy, hungry, and hot. You will sleep in hammocks and spend up to 6 hours in small boats on wooden benches. The ability to call/email home will be limited for up to 2 weeks at a time. There will be spiders that are larger than your face. And bats. What do you think about living like this for a month or more? Global health work, especially the kind we are in, requires a great deal of flexibility. During the year, it’s easy to be productive from the comforts of your own home or a local coffee shop. However, when you have a million tasks on-site, the internet is slow, and you barely know where to buy pens, your ability to cope, stay positive, and roll with the punches is crucial. Please comment on your skills in this area. You are on a first date with somebody new. By the end of the night, what do you want that person to know about you as a person? What questions do you have for CU Peru?