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Applicant Information

Trip Dates are March 12-19, 2019.  Trip cost is $1,400.

Your application and a non-refundable deposit of $150.00 is due by December 28, 2018.

Final payment due February 28, 2018.

If you have technical problems with the survey, please contact Beth at 414-758-2280. If you have questions about the program, please contact Antoinette Mensah at 414-758-2282.

PAGE 1: PERSONAL INFORMATION:

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* 1. Please provide your contact information:

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* 2. What is your date of birth? (please use format MM/DD/YYYY)

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* 3. Do you have a valid passport? (Passport must not expire for at least 6 months after the return date of your trip.)

Please Note: You do not need to have a passport to submit an application. However, you will need to have a passport at least two weeks before departure. (Please note that passports must not expire for at least 6 months after your trip dates.)

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* 4. If you already have a valid passport, please enter the following information:

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* 5. Emergency Contact Person(s):
(at least one person's name and phone or e-mail address is required)

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* 6. Do you have any health or dietary restrictions?

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* 7. Do you speak any Spanish or Creole? (you can indicate your level in questions 7 & 8)

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* 8. If you speak Spanish, please indicate your level of proficiency:

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* 9. If you speak Creole, please indicate your level of proficiency:

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* 10. PARISH AFFILIATION: If you are a member of a local parish, please enter its name and location.

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* 11. Please indicate your level of experience with the Archdiocesan Sister Parish “La Sagrada Familia” in the Dominican Republic (choose all that apply):

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