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Application Form


P 01 Costa Rica / P 02 / P 03 / P 06 / P 08 Costa Rica / P 017 A HMS /


    Please read all the instructions and requirements carefully before completing this form!
    Please choose the program you wish to apply to:



      Last Name    First Name    Middle Name



      Mailing Address

      Phone number


      Male          Female


    Information about your Home Institution:

    Name of your Advisor

      Name of Home Institution

      Mailing Address

      Phone number



      Please indicate your year of graduation.


    Spanish is: (Please check the appropriate)

      Mother tongue

      Very Good


      Not Very Good


    Did you attend any Spanish training?




    What type of training did you attend?

      Immersion in a Spanish speaking environment

      Self direct course

      University/ College Intensive Course

      High School course



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



    How long ago did you attend your training?

      Six Months

      One Year

      More than 2 years


              IHCAI may request proof of the Spanish proficiency level.


    Please indicate the period during which you wish to study at IHCAI:

    From:  To:    Number of weeks:


    Please write your motivational statement in the field below (no more than 100 words). If you feel that your Spanish is not

    adequate you may write it in English.



    Please indicate any special requests, such as medical conditions needing particular attention, food restrictions or requests,

    religious preferences or any other special needs below.



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

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



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


International Health Central American Institute

IHCAI Foundation has its headquartes in San Josť, 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 Josť, 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