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Highland Support Project
Serving Mayan Communities of Guatemala
APPLICATION
Midwifery & Health in the Americas: Marrying Mayan & Western Medicine
Service-Exchange Program – August 2 – 9, 2014
Hosted by the VCU Institute for Women’s Health, and the
Highland Support Project, Partners in Service Program
Name: __________________________________________(exactly as it appears on your passport)
Date/Year of Birth ________________________________________________________________________
Address: ___________________________________________________________________________
Daytime phone: _________________________________ Evening or cell phone: _________________
E-mail address: _____________________________________
Occupation: ________________________________________
Passport number: _______________________________ Nationality: _____________________
Passport expiration date: ___________________________________
How did you learn about the program?
Please share why you would like to participate in this program?
Have you had any previous international experience? If yes, please detail.
Please tell us about any relevant experience in Guatemala or elsewhere in Latin America, and/or with
women’s health, maternal and/or child health?
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Do you have any personal objectives and expectations for this trip?
Detail any other jobs, experiences, or qualifications that you believe would be relevant.
Do you have any preliminary ideas on knowledge, skills or an activity you would like to share with the
Mayan midwives and/or health promoters we spend time with?
How do you anticipate using this experience in the future when you return to your community?
Please rate your language proficiency (circle one):
Spoken Spanish: fluent good fair
poor
Written Spanish: fluent good fair
poor
none
none
Note: We will be ‘living’ and working in Quetzaltenango which is located in a mountain valley at an elevation
of about 7,655 ft. Some short term hiking may be involved and it often rains a lot at this time of the year. If you
have any health concerns or physical limitations related to these conditions please note above.
Do you have any health conditions that might be a concern while traveling? ____ YES ____NO
IF YES PLEASE EXPLAIN:
I am interested in having HSP purchase a ticket for me as part of the group
Yes _______ No _______ (More info will be provided as soon as we get all the flight purchase decisions)
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_________________________________________________________________________________
PLEASE RETURN THE ABOVE 2 PAGE APPLICATION FORM by April 25, 2014
Send to Janett Forte, by e-mail to: [email protected] or by fax to (804) 827- 0957 or by mail to:
Institute for Women’s Health, PO Box 980319, Richmond, VA 23298-0319
If selected, a non-refundable deposit of $250 is due by May 2, 2014
The total cost of the exchange is $985.00 per person to cover coordination, logistics, food,
lodging, in-country transportation, cultural activities and language translation. Trip emergency
medical, evacuation, and liability insurance is also included. The deposit will be included in this cost.
We kindly ask that participants pay in full by July 2, 2014
For questions or clarifications, please contact Janett Forte, [email protected] or at (804) 827-1200
Notices of application acceptance will be sent by April 30, 2014
Some Preliminary Logistics – FYI
Trip Details: The standard 8 day trip with all expenses paid includes all in country transportation, food, lodging
cultural activities and translators. The cost is $985.00 plus airfare, which is usually about $600.00. This fee
also covers the cost of the emergency medical, evacuation, and liability insurance policy that covers every
traveler on the trip.
Airfare:
There are a few options for purchasing airfare for your service trip. HSP is more than happy to find and
purchase airfare for the team, or individual team members may purchase their own tickets.
If team members are purchasing their own airfare, it is ideal that all team members travel on the same flight,
and HSP can facilitate communication between team members regarding available flights and travel options. It
is IMPERATIVE that team members arrive in Guatemala NO LATER THAN 2:00 pm! This is required to
ensure the safety of the team as they travel out of Guatemala City.
If HSP is purchasing airfare for the team, airfare will be purchased after team members remit an airfare
deposit, typically included with the 2nd trip payment. HSP will not purchase a plane ticket before payment has
been received. Once tickets are purchased, the team members for whom the tickets are purchased are
responsible for any additional airfare related costs needed, including, but not limited to, baggage fees and
ticket changes.
The round trip cost is around $600. We will search for the best price and travel logistics. Flights are generally
out of the Washington DC area – either DCA or IAD airports. HSP can purchase your airfare out of Richmond,
but this usually costs more.
Trip Planning Meetings:
Information Session:
A pre-trip planning meeting will be hosted by Janett Forte in late June or early July at the Institute for Women’s
Health. We will have a chance to begin to build our team - sharing ideas and interests. At the meeting we will
provide more information on the context for women’s health in Guatemala, including some history on health
related trips and health initiatives in Guatemala. We will provide updates on trip logistics, completion of
paperwork, and encourage input for our in-country project itinerary. We’ll address any questions related to final
logistics, packing recommendations etc.
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Trip Timeline and deadlines
ALL APPLICATIONS ARE DUE by April 25, 2014
Notices of application acceptance will be sent by April 30, 2014
Payment Schedule
The total payment for the trip is $985.00. Your program fees cover food, lodging, interpretation, meeting
facilitation, and transportation within Guatemala. This fee also covers the cost of the emergency medical,
evacuation, and liability insurance policy that covers every traveler on the trip.
Deadlines - The trip is scheduled for Saturday August 2 to Saturday August 9, 2014
A non-refundable deposit of $250 is due by due by May 2, 2014
May 27, 2014 –notify us of your decision about purchasing airline tickets.
May 30 2014 - purchase your own air fare deadline – send us your flight details.
June 6, 2014 - Second Payment of $367.50 and airfare*(about $600.00) due. (Generally the earlier we
purchase tickets for the group– the better the price)
If HSP is purchasing your airfare and the true ticket cost is different from the $600 estimate, the final
payment will be adjusted to reflect the difference in cost.
If you’re purchasing your own airfare, your 2nd payment will not include airfare cost and is then
($367.50)
30 days before departure date = July 2, 2014
Remaining balance of payment due ($367.50) or the difference based on adjustment for airfare cost for those
that had HSP purchase tickets
Saturday, August 2, 2013 – on our way – Depart for Guatemala
*********
Checks are made payable to Highland Support Project and need to be mailed to HSP c/o Rachel Triplett - PO
Box 7185 Richmond, VA 23221 or dropped off to Rachel at the HSP office 700 W. Franklin Street, Richmond.
Call ahead Rachel’s cell # is 241-2881
1-16-14 (jf)
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