CO-OP APPLICATION
Co-op Information
Co-op Code:
1010 TEFL & Teaching 1011 Teaching 1001 Government 1002 Management 1003 Marketing 1004 Journalism 1005 Hotel Management 1006 Hotel Hospitality 1007 Catering 1008 Children Tutor 1009 Summer Camp
Program Dates for 2005/2006
Fall 2006 session winter 2006 session Spring 2006 session
Personal Information
First Name :
Middle Name:
Last Name:
Male Female
Email:
Confirm Email:
Current Address:
Tel:()
Mobile ()
Permanent Address:
Tel: ()
Which address would you like us to use for correspondence? Current Permanent
Social Security Number:
Date of Birth (DD/MM/YY):
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Country of Citizenship:
Highest Level of Education Completed:
Other academic qualifications held:
Are you currently enrolled in an educational program? Yes No
If yes, what institution?
In what degree or course?
Current standing (if applicable): Sophomore Junior Senior
Is English your native language? Yes No
Please attached your resume/CV to this form
Personal Statement
(Please let us know your reasons for wanting to participate in the program)
Have you traveled or studied abroad previously? Where and for how long?
How did you hear about us?
By submitting this document to The New Village School Internship in Italy Project, I hereby agree:
I, (your name), hereby certify that the statements I have made on this application are true and correct and I will contact The New Village School office with any changes or be subject to potential dismissal. I authorize The New Village School office to forward copies of these documents to selected intern hosts.
I acknowledge that international travel involves risks, including the possibility of illness, adverse weather conditions, travel delays, strikes, and other work stoppages, hostile actions by governments or individuals, and other risks and inconveniences, whether or not similar. I acknowledge that the The New Village School Office is not responsible for the activities of persons not employed by them. On behalf of myself and heirs and assigns, I fully and forever release The New Village School and its officers, directors, managers, members and employees, and agree not to seek compensation from any of them, for any losses that I may suffer during my co-op or during travel to and from my co-op program.
I will abide by the laws, rules, and regulations of Italy throughout the time I am serving my internship, and will endeavor to comply with all local customs.
I will carry out my duties as an intern in an organization in Italy to the best of my abilities.
I will pay my way, to and from my home country and Italy.
I will indemnify The New Village School and its officers, directors, managers, members and employees against all loss or damage and any claims made against any of them as a result of any breach by me of the undertakings and agreements set forth above, or any negligent actions or inactions by me during the course of my participation in the co-op program. The program fee is not refundable. However, students prevented from taking part in the co-op will receive a credit voucher which can be used within the next 12 months; beyond this period the course will be considered annulled.
I have read the terms and conditions stated above and agree to all of these terms and conditions.
By Entering my name and clicking on "submit" below, I am agreeing to the above statements*.