Office of Latino/Latin American Studies (OLLAS)
Arts and Sciences Hall, 106
University of Nebraska at Omaha
6001 Dodge Street
Omaha, NE 68182
Telephone: 402-554-3835
Registration Form
Certificate in Latin American Service Learning - PERU 2011
Travel Dates: June 5-21, 2011
Instructor: Olga Celle, Ph.D.
Complete the following information to register for the Certificate in Latin American Service Learning.
Participation in the Latin American Service Learning project will take place in Lima, Peru beginning
June 5, 2011.
The registration form and a non-refundable deposit of $150 are due to the Office of Latino/Latin
American Studies by December 6, 2010. The approximate total cost of the program that will be paid to
UNO is $1,850 (excluding airfare) and includes hotel, two meals per day, local transportation, tips,
special lectures, and the cost of the service learning project.
This non-credit program covering the basics of Service Learning in Latin America includes the
following topics:
1.
2.
3.
4.
5.
6.
Service Learning at home and abroad : Lessons for both sides and future work
Multicultural exchange, cultural norms, and history
Local government, civic engagement, & community leadership
Globalization, the informal economy and international commerce
Education and social inequality
Health and the environment in urban Latin America
Payment Information
The deposit (first payment) is due January 14, 2011.
The second payment (half of the registration costs less the deposit of $150) will be due on
February 1 and is necessary for us to hold your space at the hotel.
A final payment will be due on March 16. This payment is necessary by this date in order for the
planning and construction of the service learning project to begin.
Personal and miscellaneous expenses as well as airport fees, travel insurance (required), meals,
and travel outside of the set plan are your responsibility. We recommend you bring between $100150/week.
All payments can be made by personal check or credit card.
Please contact Yuriko Doku for further information or with questions.
402-554-3835 or ydoku@mail.unomaha.edu
Registration Form
Full Name (as appears on passport):
Home Address:
street
city
state
Birth Date:
Birth Place
Passport Number:
Exp.Date
zip
Passport issued by (country)
Citizenship:
Previous International Experience__________________________________________________________
Employer______________________________________ Job Title :
Why are you interested in traveling to Peru? __________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
What special skills do you have that may be useful during the trip (e.g Spanish language fluency level,
construction, media, organizational)
________________________________________________________________________________________
Email:
Telephone:
Fax: (
daytime
(
)
)
evening
(
)
Mother’s Maiden Name:
Emergency Contact Number:
Gender:
F
M
If not a U.S. citizen, number of Alien Registration Card or type of U.S. Visa
* Very important: Please return this form and a non-refundable $150 deposit check
made out to UNO no later than December 6, 2010. Please make sure that you have
accessed and viewed all relevant information from the U.S. Department of State
website (www.state.gov) regarding travel to Peru. Please make sure that your passport
is current, that you have all of the required vaccinations, and that you have purchased
the appropriate overseas medical insurance for the trip.