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:

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.

International Perspectives:  Xicotepec
The "International Perspectives: Xicotepec" course is an inter-disciplinary, international service-learning course offered by the University of Iowa in collaboration with Rotary International District 6000 and the Club Rotario de Xicotepec de Juárez, A. C. An instructor's permission is required to enroll in the course.

Course instructors and enrolled students, please complete this online application. The information you provide will be used by the Rotary Coordinators of the Xicotepec Project of Rotary International District 6000. You are not providing information to the University of Iowa by filling out this online application.

Rotary Club Affiliation
Participation in The Xicotepec Project as a Project Team member is open to Rotarians, Rotaractors, Interactors, Junior Rotarians, and members of their immediate families. Please indicate your affiliation.

Interactor's Faculty Advisor

Family Members of Rotarians, Rotaractors, Interactors, Junior Rotarians
Please enter the name and birth date of the Rotarian, Rotaractor, Interactor, Junior Rotarian, or student sponsored by a Rotary Club who is also applying to travel on this trip and to whom you are related.

Non-Rotary Affiliation

Rotary District 6000

Club Information
Please provide a club name by choosing one of the following drop-downs based on your affiliation.

Rotary Outside District 6000
This page is to be used if you or your immediate family member is a member of a Rotary Club, Interact Club, or Rotaract Club located outside of District 6000 OR if you are a Junior Rotarian being sponsored by a club outside of District 6000.

Personal and Contact Information


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? 

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.

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

Please read the following statements and indicate that you agree to them:
  1. I agree to have in my possession a valid passport no later than 31 December 2019.
  2. I understand a passport card cannot be used.   
  3. I understand that the passport must not expire until after 22 September 2020.
  4. 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.

Passport Upload


e.g. JONES

Travel Information

Applicants Over 18


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.

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

Optional information for second contact:

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:


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).

Applicants Over 21

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.

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.

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

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."
1 2 3 4 5 6 7 8 9 10
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.

All 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

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.


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.

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