Ceiba Foundation - Tropical Conservation Semester Enrollment Form

TCS 2012

Enrollment & Pre-Departure Instructions

Enrollment Deadline: Third Friday in October

Congratulations on your acceptance to the Tropical Conservation Semester in Ecuador! We are happy to have you join this learning adventure, which begins in only a few short weeks!

Now that you've been accepted, there are several steps you must complete to enroll in the program and prepare for departure. Foremost among these is submitting an enrollment form to confirm your participation in the program; we must receive this form before the deadline or your spot will be awarded to an applicant on the waiting list. This form also contains information used to pair you with your host families in Quito and the Galapagos. Below is a complete list of the steps you must complete before you travel to Ecuador.

Fill out the online Enrollment Form below (*must be completed by deadline). Note: You cannot save this form; please have all information in hand before filling it out and submitting it.

Sign the program liability waiver and mail to Ceiba.

If you don't yet have one, apply for a passport immediately and email a scanned copy of the photo page to Ceiba.

Obtain a "12-VIII Cultural Exchange" visa for Ecuador before you travel (see instructions).

Read the TCS Program Packet and Frequently Asked Questions about traveling to Ecuador.

Purchase your plane ticket and submit your travel itinerary to Ceiba using the online form. The arrival date strongly recommended by USFQ is January 4; the final day of program academics is May 18, so the earliest possible departure date is May 19 .

Obtain a yellow fever vaccination (why do I need this?).

Take the USFQ online Spanish placement exam (instructions will be emailed to you).

Pay your program tuition. The University of Wisconsin or your home institution will bill you for tuition and administrative fees.

Purchase course textbooks (Spanish texts will be provided in Ecuador) and other required materials. See the TCS Program Packet for lists of what to bring!

Tropical Conservation Semester -- Enrollment Form

*form temporarily disabled

Personal Information

Email:*

First Name(s):*     Last Name:*

Passport Number:

*Please see below for more passport information.

Diet and Health Information

Please check all the foods that you WILL eat:*

chicken   beef   pork   fish   eggs   dairy

Please specify any other dietary restrictions:*

Please describe your swimming ability:*

Please indicate if you have allergic reactions to any of the following:*

Yes No   -  Penicillin
Yes No   -  Other Antibiotics
Yes No   -  Other Medicines
Yes No   -  Insect Bites or Stings
If you answered Yes to any of the above, please provide a detailed explanation, including the types of medicines and/or insects to which you are allergic:

Please indicate if you have had or are presently experiencing any of the following:*

Yes No   -  Asthma
Yes No   -  Bleeding Disorder
Yes No   -  Cancer
Yes No   -  Colitis
Yes No   -  Diabetes
Yes No   -  Epilepsy / Seizures / Blackouts
Yes No   -  Heart Disease
Yes No   -  Hernia
Yes No   -  High Blood Pressure
Yes No   -  Joint Injury / Surgery
Yes No   -  Kidney Disease
Yes No   -  Mental / Emotional Problems / ADHD
Yes No   -  Neck / Back Pain / Injury
Yes No   -  Rheumatic Fever
Yes No   -  Tuberculosis
Yes No   -  Ulcer
If you answered Yes to any of the above, please provide a detailed explanation, including how recently you have experienced the condition and what routine treatments you require:

Please list any prescription drugs you take on a regular basis (not already mentioned above):

Host Family Preferences

Do you prefer a host family with children that are:*

      University-aged      Adolescent       Pre-school      No children

Are you a smoker?* Yes      No

Do you prefer a host family with pets?* Yes      No

Do you engage regularly in sports?* Yes      No

If you answered yes, which sport(s)?

Do you like playing or listening to music? Yes      No

Briefly describe the most essential characteristics of your personality that will allow program staff to select a host family best suited to you: *

Emergency Contact Information

Name:*

Relationship:*

Address:*

City:*

State/Province:*      Zip:*

Country:

Day phone:*

Night phone:*

Alternate phone:

Email:

Alternate Emergency Contact

Name:*

Relationship:*

Phone:*

Alternate phone:

Physician

Name:*

Phone:*

Medical Insurance Provider

Program participants are required to have a valid insurance policy that provides coverage while engaging in a field education program in a foreign country. Please provide policy information below:

Company:*    Policy Number:*

Address:*

Phone:*    Valid through:*

Enrollment Verification*

I understand that by enrolling, I am responsible for paying tuition (see Refund Policy) and completing other required steps to prepare for my semester in Ecuador. I certify that information provided on this form is true and correct.

Yes       No

E-Signature (Please type full name):*

Date submitted (mm/dd/yyyy):* / /


Clicking “Submit Form” will send your enrollment and show your completed form -- click the "Back" button in your browser to return from the confirmation message. Click “Clear Form” to start over.

Liability Release

Liability Release Waiver

Please download, print and sign the program release and waiver of liability. This is a standard legal waiver similar to those signed by participants in any outdoor program conducted overseas. By signing, you certify that you are aware of and accept the risks inherent in international travel. UW students may turn this form in during the program orientation on the Madison campus. All other students, please mail the original signed form to Ceiba's office.

US passport

Passport

You must have a valid passport to travel to Ecuador, and it must be valid for at least 6 months beyond the date of your arrival. If you do not have a passport, apply for one immediately. It can take up to 6 weeks to obtain a passport, and you cannot apply for a visa until you have one. Passport applications can be completed at most large US Post Offices or State Department offices. For more information visit the U.S. State Department passport website. As soon as you receive your passport, please submit your passport number to us via email.

As soon as you receive your passport, please submit a color scan of the photo and signature page to us via email. We need it to make reservations at numerous research sites and the Galapagos. Please ensure the resoution is sufficient to read all the numbers clearly; either pdf or jpg format is acceptable.

Instructions: Obtaining your Ecuadorian Visa

Visa Information

All students must obtain a cultural exchange visa (also known as a "12-VIII" Visa) from the nearest Ecuadorian embassy or consulate prior to departing for Ecuador. Please note that you may not attend this program without obtaining this visa, and Ceiba is not responsible for the consequences, financial or otherwise, if you do not secure a proper visa.

START EARLY because obtaining an Ecuadorian visa is a multi-step process that often must be done in person (depending on state) and requires some time. If you are waiting for your passport, you can still get started by getting together all the other required documentation. A letter from the Universidad San Francisco de Quito that is required for obtaining your visa will be sent to you separately, and they will provide ongoing assistance during the process.

We provide step-by-step instructions for obtaining your visa, however procedures vary from state to state and may change at any time, so we strongly recommend you call the Ecuadorian Consulate where you will be obtaining your visa to verify the proper procedure.

TCS Program Packet

Frequently Asked Questions

TCS Program Packet & Frequently Asked Questions

You must read the TCS Program Packet prior to traveling to Ecuador. The packet contains important information on the sites we visit, what to bring, course content and activities, required textbooks, and travel details.

If you have further questions, please the FAQ for the Tropical Conservation Semester. Included are answers to common inquiries about preparation, arrival and living in Ecuador.

Of course, we are here to help you should you need us. Feel free to contact Ceiba at any time.

Itinerary

Travel Itinerary

We recommend you purchase your ticket to Ecuador as soon as possible to get the best available fare on the recommended arrival date. As soon as you purchase your ticket, please submit the itinerary form below. Since we use this information to schedule your airport pickup, you must notify Ceiba of any changes to this itinerary prior to your departure. See the FAQ sheet for more details on arriving in Ecuador.

Travel Itinerary Form

Please provide information on ALL segments of your journey.

Name:

Email:

Travel to Quito:

Date (mm/dd) Airline Flight # Depart Time Depart City Arrive Time Arrive City

Travel from Quito

Date (mm/dd) Airline Flight # Depart Time Depart City Arrive Time Arrive City



Clicking “Send Itinerary” will send your itinerary and show your completed form -- click the "Back" button in your browser to return from the confirmation message. Click “Reset” to start over.

If you have any questions regarding the enrollment process, please contact Ceiba.

Immunization Book

Yellow Fever Vaccination

You must obtain a valid yellow fever vaccination to travel to the Tiputini Biodiversity Station in the Amazon rainforest. You will be asked to present proof of vaccination (typically in the form of a standard "Yellow Book" immunization record, which you should ask your physician to complete when you are vaccinated) when passing through oil company territory we must cross to reach the station. The vaccination is a simple shot that can be obtained from most health clinics, personal physicians or travel clinics. Vaccinations are valid 10 days after being administered, and are good for a period of 10 years. Please be aware that yellow fever is not a concern at the Tiputini station; however, proof of vaccination is an inflexible requirement of the oil company, and no exceptions will be made: if you do not have proof of vaccination, you will not be allowed to travel into the Amazon. For additional information on travelers' health please consult the Centers for Disease Control (CDC) .

Tuition

Program Tuition

If you are applying through the University of Wisconsin's Office of International Programs, you will receive a bill from the UW Bursar for the program tuition plus administrative fees; if you are not a UW student you may receive this bill directly from your home institution. U.S. and Canadian participants should contact the UW study abroad office with any questions on tuition payment. Participants from outside the U.S. and Canada should contact Ceiba for tuition payment instructions.

Refund Policy

Program tuition and fees are not refundable after the program enrollment deadline; however, in the case of a documented emergency including illness, incapacitation, or death of the student or immediate family before the start date of the program, tuition will be refunded less a $500 cancellation fee. After the program start date, no refund will be given. If the program is cancelled by Ceiba for any reason prior to the start date, tuition will be refunded in full.