Cucuyo Student Application

  • Personal Information

    Note: It is not possible to save and return to this application. You may want to draft your answers in another program such as Microsoft Word prior to submitting your application.
  • Full Name *
    As it appears on your passport or birth certificate
  • Date of Birth *
    MM
    /
    DD
    /
    YYYY
     
  • Phone Number *
    (###)
    -
    ###
    -
    ####
     
  • Email *
  • Skype User Name
    Cucuyo recommends a free Skype account. www.skype.com
  • Address *
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • Are you a United States citizen? *
    Yes
    No
  • Please describe any medical or social needs you may have and list any regular medications.
  • Any dietary needs such as vegetarianism or food allergies?

  • Family Information

  • Parent or Legal Guardian 1 *
    First
    Last
     
  • Parent 1 Phone *
    (###)
    -
    ###
    -
    ####
     
  • Parent 1 Email
  • Parent or Legal Guardian 2
    First
    Last
     
  • Parent 2 Phone
    (###)
    -
    ###
    -
    ####
     
  • Parent 2 Email
  • Parent Skype User Name(s)

  • A Bit About You

  • Please describe your education in or experience with the Spanish language. *
  • What hobbies and/or extracurricular activities do you participate in? *
    If you have theatre or art experience, please describe them here.
  • Why do you wish to participate in Cucuyo and what do you hope to gain from the experience? *
  • What was the most important thing you learned within the past year and why is it valuable to you? *
  • Please share how you found out about Cucuyo.
  • What is your favorite ice cream topping?

  • Thank You!

    You will receive a confirmation e-mail upon submission.