2020 Xicotepec Trip Application

Welcome to the online application form for the March 2020 Xicotepec Project Trip!

The deadline for submitting your complete application (including the required $200.00 deposit, if applicable) is midnight, Sunday the 3rd of November.

Before beginning to fill out the application, you may want to:

prepare your Statement of Purpose (75 words or less)
prepare your Brief Bio (75 words or less)
have a scanned copy or image of your passport image page and signature page ready to upload
have a "headshot" image of yourself for the participant directory ready to upload
if you are 18 or younger, have contact information for parents/guardians
if you are 18 or younger, have an email address for a reference

Before proceeding, you must read the Conditions of Participation and Other Information:

UI Students enrolled or planning to enroll in the Service-Learning course, click here to download document.
All other applicants, click here to download document.

Please confirm that you have read and that you agree to the "Conditions of Participation and Other Information."

I have read and agree to and accept the Conditions of Participation

The Xicotepec Project is a project of Rotary District 6000. Each year since 2007, the University of Iowa has participated by offering a service-learning course in the spring semester. Current University of Iowa students must participate in the service learning course offered in the spring term. If you are a University of Iowa student and you haven’t affiliated with one of the service learning classes, please contact Leslie McNeilus (leslie-mcneilus@uiowa.edu) for more information. If you have enrolled in the upcoming spring semester course, "International Perspectives: Xicotepec," plan on enrolling, or if you are a course instructor, you should check "Service-Learning Students and Faculty" below.

All other applicants (including Rotarians, Rotaractors, Interactors, Junior Rotarians, family members, youth who are endorsed by a District 6000 Rotary Club, and others), check "All Other Applicants" below.

Please indicate your applicant type below.

University of Iowa Service-Learning Students and FacultyAll Other Applicants

Personal and Contact Information

First Name

Middle Name

Last Name

Email

Address Line 1

Address Line 2

City

Country

State

Province

Postal Code

Phone (home)

Phone (mobile)

Phone (work/other)

Birth Date (mm/dd/yyyy)

Gender

MaleFemaleOther

Documentation

The following statements and documents are required. All documents can be uploaded in a variety of formats.

Application Documents

Statement of Purpose

Please provide a brief statement (75 words or less) of why you wish to participate in The Xicotepec Project. Suggestions include:

What hopes, expectations or goals do you have and how will your participation in the Project help to fulfill them?
In what way do you think you can contribute to the Project?

Statement of Purpose (75 words or less)

Brief Bio
This will be your first introduction to many of the other team members and to those in Xicotepec – what would you like them to know about you? This brief bio will be used in a Project Team Directory that will be distributed to the rest of the project team and to our Rotarian hosts in Xicotepec. Note: You may not ask that we use prior years' entries. Please write a new one.

Brief Bio (75 words or less)

Photo of Yourself (may be image, document, etc.)

Uploaded file may be cropped due to spacing limitations in the Participant Directory.

Passport

To travel on the Xicotepec Project, you must have a valid passport. A passport card cannot be used.
Your passport must be valid for six months after the trip is over. This means your passport must not expire until after 22 September 2020.
If you do not have a valid passport, you must have one by 31 December 2019.

Do you have a passport that is valid until at least 22 September 2020?

Yes, my passport will be valid for six months after the trip is overNo

Please tell us why you do not have a passport that is valid for six months after the trip dates.

I have applied for a US passportI am a US citizen and do not have a passport and have not yet applied for oneI am not a US citizen and do not have a passport and have not yet applied for one

Please read the following statements and indicate that you agree to them:

I agree to have in my possession a valid passport no later than 31 December 2019.
I understand a passport card cannot be used.
I understand that the passport must not expire until after 22 September 2020.
If I do not send in the requested passport information to the Xicotepec Project by 31 December 2019, I will be disqualified from the trip and will lose any deposit(s) paid.

Please check Yes that you have read and agree to the above statements:

Yes

Passport Upload

Passport Image and Signature Pages (scanned image that includes passport photo page AND passport signature page)

Passport "Given Name" shown on passport (ALL CAPS and exactly as it appears)

e.g. MARTHA SUSANNA

Passport "Surname" shown on passport (ALL CAPS and exactly as it appears)

e.g. JONES

Passport Issuing Country

Passport expiration date (mm/dd/yyyy)

Passport number

Travel Information

Group travelers typically travel from either Chicago (after taking a group bus from Iowa City) or Des Moines. Will you be traveling from Chicago or Des Moines?

Chicago (after taking group bus from Iowa City)Des MoinesOther/I don't know

Group travelers will fly on American or Interjet Airlines (codeshare partner with American). If you have an American or Interjet Airlines frequent flyer number, please enter it here. This will be added to your ticket upon booking.

Please enter your TSA pre-check number or Global Entry number if you have one.

Applicants Over 18

Will you be 18 or older when the trip begins on 14 March 2020?

No, I was born after 14 March 2002.Yes, I was born on or before 14 March 2002.

Parent/Guardian

You will be under 18 on 14 March 2020. Will your parent or guardian be traveling with you? This in no way affects your application status. We just need to know.

NoYes

All correspondence will be copied to your parent or guardian. Please enter their contact information below.This information will also serve as your emergency contact while you are on the Xicotepec Project trip.

Parent/Guardian First Name

Parent/Guardian Last Name

Address

Country

State

Province

City

Postal Code

email

Phone (preferred)

Emergency Contact Information

Please enter emergency contact information we can have on file while you are on the Xicotepec Project trip.

Emergency Contact Name

Address

Country

State

Province

City

Postal Code

email

Phone (preferred)

Optional information for second contact:

2nd Emergency Contact Name

Address

Country

State

Province

City

Postal Code

email

Phone (preferred)

Youth References

As a youth, part of the application process is to provide us with a reference. The Xicotepec Project is looking for students who demonstrate the attitude, work ethic, and integrity to help make this year's project successful.

If you have been accepted on a previous Xicotepec trip and provided a reference at that time, no further reference information is needed. Otherwise, please select a teacher, school counselor, or principal and refer them to the following link to fill out a reference for you:

https://xicoproject.org/youth-reference-form/

It is your responsibility to ensure your reference person submits a reference for you on time. Your application is not considered complete until a reference is received. The reference deadline is 3 November 2019.

Youth Reimbursement

If you are a Rotary District 6000 Interactor, Rotaractor, or a youth participant sponsored by a D6000 Rotary Club and you have not previously received reimbursement for past trips, you may be eligible to apply for a partial reimbursement of travel expenses paid by you to The Xicotepec Project.

You may be reimbursed up to half of your out-of-pocket expenses paid to the Xicotepec Project (i.e., trip cost less financial assistance from sponsoring clubs), provided funds are available, and provided the total of all youth reimbursements for the 2020 Xicotepec Project does not exceed $10,000.

Reimbursements are granted by the District 6000 Youth Fund Committee and not by The Xicotepec Project. The Youth Fund Committee sets the conditions for obtaining reimbursements and any decision to reimburse is made by the Committee. Instructions for applying for partial reimbursement will be sent after the trip is over.

Health Insurance and General Health

You must have adequate health insurance coverage while in Mexico. Failure to carry insurance may result in denial of permission to participate in the project, forfeit of any fees paid or denial of treatment while outside the US. Please read the statement below and check the box to indicate your agreement to these conditions (if you are under 21, you will also be provided with a form which a parent or guardian must sign).

I understand the need for health insurance while traveling abroad and will, if not already covered, purchase a policy and, if asked, provide the pertinent information to the Project Coordinator before I am allowed to participate in The Xicotepec Project. I certify that my health care insurance coverage will be maintained for the duration of the Project trip. I understand that failure on my part to obtain health insurance may result in dismissal from the Project Team and forfeiture of any fees paid.

Yes

My overall health is:

ExcellentGoodFairPoor

Do you have any medical condition, dietary restrictions, allergies, etc. which might affect your ability to travel to or spend time in a developing country?

NoYes

Please provide details of your medical conditions, dietary restrictions, allergies, etc. which might affect your ability to travel to or spend time in a developing country.

Applicants Over 21

Will you be 21 or older when the trip begins on 14 March 2020?

No, I was born after 14 March 1999.Yes, I was born on or before 14 March 1999.

Parent/Guardian

You will be under 21 on 14 March 2020. A health insurance form will be sent to your parent/guardian for them to sign. Please enter their contact information below.

Parent/Guardian Name

email

Phone (preferred)

Spanish Language

Spanish is not required to participate in the Xicotepec Project, but it will help the Project Coordinators to know about your proficiency in Spanish.

Is Spanish your first language?

YesNoCheck "Yes" if Spanish is your first language or you have spoken Spanish continuously since childhood.

What is the highest level of coursework in Spanish that you have completed?

None or virtually noneUp to 2 years of high school or 2 semesters of collegeMore than 2 years of high school or 2 semesters of collegeMore than 4 semesters of college

Please rate the following on a scale of 1 to 10 with 1 being "None or only simple phrases" and 10 being "Near-native mastery."

Next Steps

So that we send you the appropriate waiver forms to electronically sign, please tell us about your marital status. We only use this information to send you the correct form(s) to sign. Thank you.

Are you married?

YesNo

Spouse First Name

Spouse Last Name

Spouse Email address

Spouse Preferred Phone

Lodging Arrangements - indicate your preferred hotel lodging in Mexico City

I would like to share a room and the cost with one or two other peopleI would like an individual room for myself (may incur additional charge)Either is fine with meAll project team members will travel using ground and air transportation arranged by The Xicotepec Project. If for some reason you feel you must make your own travel arrangements, they must be approved by the Project Coordinator.

Thank You

Thank you for your application.

After you click the Submit button on the next page, your application will be considered complete.

Applicants who have completed the application prior to the 3 November 2019 deadline will be notified of their application status in late November. All trip payments will be handled by the University of Iowa.

Thank You

Thank you for your application.

Unless you have been told otherwise, you must pay your $200 deposit for your application to be considered.

After you click the Submit button on the next page, you will be directed to pay the deposit. Once your deposit is received, your application will be considered complete.

Applicants who have completed the application process and paid their deposit prior to the 3 November 2019 deadline will be notified of their application status in late November. If you are not accepted for this year's trip, your deposit will be refunded in full. Any applicant who withdraws prior to acceptance will have their deposit returned in full. Once an applicant has been accepted, their deposit becomes non-refundable.

Additionally, once an applicant has been accepted, another trip payment must be received by 6 December 2019 and final trip payment must be received by 12 January 2020. Please plan accordingly. Payment instructions will be emailed upon acceptance.

Participant Information

First Name

Last Name

Have you been told you are not required to pay the $200 deposit at this time?

YesNo

Payer Information

Sometimes the person paying the deposit is different from the person attending the trip. Please enter the contact information for the person paying the deposit.

Payer First Name

Payer Last Name

Payer Email Address

Deposit

Please click the Submit button below. You will be directed to a confirmation page before you choose how to make your deposit payment.

If you have questions or need assistance, please contact us at info@xicoproject.org. Thank you.

Deposit

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