Purdue Timmy Global Health
Ecuador Medical Service Trip Application
Trip dates: March 12th – 20th, 2014 (Saturday to Sunday)
Application due date: Wednesday, October 14th by 11:59pm
Cost: ~$2,250 (all inclusive)
Please send the completed application to purduetimmytrip@gmail.com saved with a filename of the
format “App2015_FirstName_LastName”.
Please insert a selfie in the space provided above :)
Name:
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Purdue Email Address:
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Local Address:
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Local Phone Number:
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Home Address:
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Home Phone Number:
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Date of Birth:
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Year at Purdue:
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Major:
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GPA:
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(Use your high school GPA if you are a freshman)
Please rate your Spanish speaking and comprehension ability. No prior Spanish knowledge or class is
required for the trip, but it is highly important that we have accurate knowledge as to how comfortable you
currently are with the Spanish language (Underline one).
No experience
Minimal
Moderate
Excellent
Fluent
Please list any Spanish classes you have taken or prolonged Spanish-speaking experiences (i.e., study
abroad, immersion programs), and the years you participated in them below.
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List and briefly explain the volunteer, job, and extracurricular experiences you have had so far at Purdue
University, and the years you participated (if you are a freshman, you may list activities from high school).
*Please precede any current, ongoing activities and positions with an asterisk.
1. Volunteer Activities
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2. Extracurricular Activities
a. Click here to enter text.
3. Jobs
a. Click here to enter text.
How did you learn about Purdue Timmy Global Health? (Underline one)
BGR
Advisor Email
Flyer
Friend
Activities Fair
Other:
Please list any past involvement with Timmy Global Health. If you have not had an opportunity to get
involved, how do you hope to do so in the future?
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What attributes or strengths would you contribute to this service trip?
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* For the remaining questions, you will not be assessed on the quantity of the words, but rather the quality
thereof. We are expecting perhaps one to two paragraphs, but you may use as many words as you need.
How does this short term Medical Service Trip fit into your long–term goals?
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Describe an experience you have had with a culture different from your own, and how has it affected your
perspectives. How is cultural understanding helpful in medicine?
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Attending this brigade will cost around $2,000 to $2,200. What do you see as the benefits of personally
participating in this brigade as opposed to donating the money directly?
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If you are not chosen to attend the Ecuador Brigade, would you be interested in volunteering on the
alternative spring break trip to Atlanta, GA? (Underline one)
Yes
No
Maybe
Additional Information
For those selected to participate in the Ecuador Medical Brigade:
i)
ii)
iii)
iv)
Trip payments will be made in three installments:
November 13: First payment due ($250)
December 11: Second payment due (~$1,000), and deposit becomes non-refundable
January 15: Final payment due (~$1000)
*Costs will be finalized within the next two months depending on flight costs
Students will be required to attend trip meetings held every other week for the fall and spring
semesters leading up to the trip. Social events on the off-weeks of the spring semester will be
strongly encouraged.
Students will participate in two retreats to encourage bonding and good organization: one on
Friday, October 23rd after trip selection and one in early to mid-February 2016
Students will participate in at least three “donation days” (Saturday or Sunday) during the Fall
2015 and Spring 2016 semesters. During donation days, Timmy Global Health members meet at
local grocery stores and pharmacies and collect donations of common healthcare items
(toothbrushes, vitamins, etc.) that are taken to Ecuador with the group. Transportation is
worked out as a group.
Will you be available to commit to fulfilling all requirements listed above? (Underline one)
Yes
No
----------------------------------------------------------------------------------------------------------------------------------------------Please email completed forms to Nick Tucker and Gao Yumin at purduetimmytrip@gmail.com, with
“App2015_FirstName_LastName” as the subject header.
Thank you very much for taking the time to fill out this application! We truly appreciate your interest and
continued involvement in Timmy Global Health, and we look forward to speaking with you more during the
interview! Click the link below to sign up for your interview time slot.
https://docs.google.com/spreadsheets/d/1W_zoM546WDGr5zhxEFLcS3VDph6uSGHMjLoaf3OfVg/edit?usp=sharing