International Health Central American Institute

Foundation


Programs

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Mission

Our location

Advice

Partnerships

 

Fórmula de Aplicación

P017 B

 

        Please choose the program you wish to apply to:

   

  

      Last Name    First Name    Middle Name

 

      Country

     Passport or ID number

      Mailing Address

      Phone number

     Mobil Phone

      Email

      Male          Female

 

    Information about your Home Institution

    Name of your Advisor

      Name of Home Institution

      Mailing Address

      Phone number

      Email

 

      Please indicate your year of graduation.

   

    English is: (Please check the appropriate)

      Mother tongue

      Very Good

      Good

      Not Very Good

 

    Did you attend any English training?

      Yes

      No

 

    What type of training did you attend?

      Immersion in a English speaking environment

      Self direct course

      University/ College Intensive Course

      High School course

      Other

 

    For how long did you attend the English classes? How many hours per week?

   

 

    How long ago did you attend your training?

      Six Months

      One Year

      More than 2 years

    

    Have you approuved the Toffel Test?

     Yes        Date              Score 

     No

 

              IHCAI Foundation and HMS may request proof of the English proficiency level.

 

    Please indicate the period during your rotation:

    From  To    Number of weeks:

 

    Please write your motivational statement in the field below (no more than 100 words) in English.

   

 

    Please indicate any special requests, such as medical conditions needing particular attention.

   

 

    Emergency contact information. Please indicate a person to be contacted in case of an emergency.

    Name, current mailing address, phone and email (if available).

 

Information and terms of reference upon request compliting this application does not garantee that the student has not been accepted.

Please make sure you have answered EVERY question before sending this form

 
International Health Central American Institute
Foundation

IHCAI Foundation has its headquartes in San José, Costa Rica, Central America.

IHCAI Foundation is an equal opportunity organization and do not make

any preference by gender, race, sexual orientation or political opinions

and rejects those openly racist, Nazi or Neo Nazi oriented.

 

IHCAI - Main Office

P.O. Box 1677-2100, San José, Costa Rica,
Barrio Escalante, San Jose, 7th Avenue, 35 and 37 Street, #3530

Tel:  (506) 2234 6354 or (506) 2234 6347   //  Fax:  (506) 2226 3047