Sex *
-- Select --
Female
Male
Birthdate *
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
State *
-- Select --
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces - Europe
Armed Forces - Pacific
Armed Forces - USA/Canada
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northern Mariana Island
Northwest Territories
Nova Scotia
Ontario
Palau Island
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Country *
-- Select --
United States
Canada
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Expiration Date *
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
State *
-- Select --
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces - Europe
Armed Forces - Pacific
Armed Forces - USA/Canada
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northern Mariana Island
Northwest Territories
Nova Scotia
Ontario
Palau Island
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Parent 1 / Primary Guardian Information
State *
-- Select --
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces - Europe
Armed Forces - Pacific
Armed Forces - USA/Canada
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northern Mariana Island
Northwest Territories
Nova Scotia
Ontario
Palau Island
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Country *
-- Select --
United States
Canada
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Parent 2 / Other Guardian Information
State
-- Select --
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces - Europe
Armed Forces - Pacific
Armed Forces - USA/Canada
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northern Mariana Island
Northwest Territories
Nova Scotia
Ontario
Palau Island
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Country
-- Select --
United States
Canada
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua & Deps
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina
Burundi
Cambodia
Cameroon
Cape Verde
Central African Rep
Chad
Chile
China
Colombia
Comoros
Congo
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea North
Korea South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
St Kitts & Nevis
St Lucia
Saint Vincent & the Grenadines
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
What is your preferred method of Payment?
Please rate the importance of a trip based on the following criteria:
Most Important *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
2nd *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
3rd *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
4th *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
5th *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
6th *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
7th *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
8th *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
Least Important *
-- Select --
Cultural Immersion
Sustainable Development Projects
Local Family Homestay
Spanish Language Training
Spanish Language Immersion
Adventure Activities
Being in remote areas and communities
Experiential learning
Historical Background
Why did you choose Al Campo International and what
do you expect to gain from the program to which you've applied?
What aspect of the course is the most appealing, and
what would you not want to miss?
Would you consider yourself an introvert or an
extrovert? Please explain.
How do you feel about traveling with a group and
living in close quarters with them for as much as 3 weeks?
Al Campo International travels in areas of the world where
flexibility is important in the success of the experience. This may require flexibility in the stated itinerary.
Are you comfortable traveling with a program in which some flexibility in the itinerary can be expected?
Have you ever traveled to a developing country in the past?
If yes, please name the country and briefly describe your experience. If no, please explain what interests you
about visiting one.
Program of First Choice *
-- Select --
Renewable Energies 7/5 - 7/26 (Nicaragua): $4300
Agriculture and Nutrition 6/21 - 7/13 (Nicaragua): $4500
Spanish, Surf & Service 6/9 - 6/22 (Nicaragua): $2500
Spanish, Surf & Service 7/21 - 8/3 (Nicaragua): $2500
Spanish, Surf & Service 7/28 - 8/10 (Nicaragua): $2500
SCUBA, Spanish & Conservation 6/15 - 6/29 (Honduras): $3200
SCUBA, Spanish & Conservation 6/29 - 7/13 (Honduras): $3200
Culture and Marine Biology 7/21 - 8/10 (The Philippines): $4000
Surf and Service for College 6/9 - 6/22 (Nicaragua): $2500
Surf and Service for College 8/4 - 8/17 (Nicaragua): $2500
College Spring Break SCUBA 3/23 - 3/31 (Nicaragua): $1460
College Spring Break Surf n Service 3/23 - 3/31 (Nicaragua): $1260
High School Spring Break SCUBA 3/23 - 3/31 (Nicaragua): $1600
High School Spring Break Surf n Service 3/23 - 3/31 (Nicaragua): $1400
St. Andrew's Spring Break$: $2300
Heathwood Hall Winterim
Mel Bride's Summer Trip
Program of Second Choice *
-- Select --
Renewable Energies 7/5 - 7/26 (Nicaragua): $4300
Agriculture and Nutrition 6/21 - 7/13 (Nicaragua): $4500
Spanish, Surf & Service 6/9 - 6/22 (Nicaragua): $2500
Spanish, Surf & Service 7/21 - 8/3 (Nicaragua): $2500
Spanish, Surf & Service 7/28 - 8/10 (Nicaragua): $2500
SCUBA, Spanish & Conservation 6/15 - 6/29 (Honduras): $3200
SCUBA, Spanish & Conservation 6/29 - 7/13 (Honduras): $3200
Culture and Marine Biology 7/21 - 8/10 (The Philippines): $4000
Surf and Service for College 6/9 - 6/22 (Nicaragua): $2500
Surf and Service for College 8/4 - 8/17 (Nicaragua): $2500
College Spring Break SCUBA 3/23 - 3/31 (Nicaragua): $1460
College Spring Break Surf n Service 3/23 - 3/31 (Nicaragua): $1260
High School Spring Break SCUBA 3/23 - 3/31 (Nicaragua): $1600
High School Spring Break Surf n Service 3/23 - 3/31 (Nicaragua): $1400
St. Andrew's Spring Break$: $2300
Heathwood Hall Winterim
Mel Bride's Summer Trip
How did you hear about Al Campo International Programs? *
What is one thing you would like to achieve on the trip? *