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Shoulder to Shoulder Global Project/Internship/Rotation (PIR) Application

Please write your first, middle, and last names.
Please write street address, city, state, and zip code.

APPLICATION

IF YES, PLEASE EMAIL YOUR IRB PROPOSAL OR DOCUMENT OF APPROVAL FOR UK AND ECUADOR TO GABRIELA.CASTRO@UKY.EDU AND CLAUDIA.HOPENHAYN@UKY.EDU.

APPLICANT INFORMATION:

This faculty member has agreed to responsible for approving the goals, objectives, activities (including research) and assignments for this educational experience, as well as performing my post-trip evaluation to assess whether the stated goals and objectives were met.
Please provide us with motivation to participate with Shoulder to Shoulder Global and any background you have relevant to community development or working with diverse populations.

FEES:

  • Rotation fee = $300 for on-going work at CMHH and preceptor time
  • Apartment = $150 per month, paid directly to apartment owner in Santo Domingo. Utilities are around $15 per month.
  • Travel Medical Insurance (TMI) = $50 app fee + $10.50 per week (Charged per week, not prorated per day)
  • Malpractice insurance = $4.70 per day
  • Airport arrival taxi = $35 (Pay directly to taxi driver)
  • Hostel in Quito = $20 per night (Pay directly at hostel)
  • Taxi from Quito to Santo Domingo = $15 - $60 (Depends on amount of luggage participant is taking)
  • Daily bus or taxi to worksite = 50 cents to $4, depends if bus or taxi.
  • Airport departure taxi = $28 (Pay directly to taxi driver)

Please note: All fees are approximate and subject to change at any time.

AGREEMENTS: