Internship Program Thailand - Global Crossroad

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					Application for Internship Program: Rural Thailand
                                                    Step 4
Application Steps:
Step 1                                              Once you get confirmation of your project(s), your host
                                                    family (or other arrangements of room and food), and local
Once Global Crossroad receives your email, we       contact addresses, you should start preparing for travel and
will reply back with answers to your questions.     obtain all necessary documents (passport, visa) and
A formal application will be attached or you can    immunization requirements.
download a formal application form our website
or apply online.
                                                    Step 5
Step 2

Complete the application form and submit it with    Once you have purchased your ticket, please fax a
a non-refundable US$200 application fee             photocopy of your passport and itinerary to our office.
(check/money order/credit card). The application
fee is deducted from the total program fee.         Step 6
Global Crossroad Guarantees placement, if not
we refund a program deposit of 200.00 USD           Pay full program fee at least 2 months in advance, You
                                                    arrive to host country, our coordinator receives you, and
Step 3                                              program starts

After receiving your application and $200
application fee, we will notify you immediately     Please complete, sign, and fax or mail this application your
and your application will be processed. Please      nearest office location:
allow us 1-2 weeks to process your application,
match your interest, and come up with the details
of your project, arrangements for room and food,    USA: Dallas (Irving) office
and answer your questions.
                                                    Global Crossroad
                                                    4425 W Airport Freeway, Suite 210
                                                    Irving, TX 75062
                                                    Fax: 972-852-7999

Personal Details
Last name                                                    First name

Home Address                                                 Mailing Address:

Phone (Home)                                                 e-mail of applicant
Phone (Mobile)
Date of Birth


Nationality                                                  Passport number
Emergency Contact Address (must include complete name, relationship, address, email address, and telephone

Please Select your first and second project of choice (please write)

First priority project:

Second priority project:

Program starts date (please write month and year):

     (1) First Monday of ______________
     (2) Third Monday of _____________

Length of stay in weeks:____________

Are you interested in a 2 -week Language and Cultural immersion program (Please circle)

     (1) Yes
     (2) No

*Joining language and cultural program helps volunteers to understand local culture, people, and ways of life. It ultimately enriches your internship
abroad experience. So, Global Crossroad encourages interns to join this highly subsidized program
Additional Information

Please explain your motivation for participating Global Crossroad Internship program:
Please explain your educational background and experience: (we suggest interns to send a recent bio-data by
an attached email file):

Please write a one-page essay explaining what you want to do as an intern. Please summarize your interests
and expectations:

Explain a time in your life when you had to go beyond your comfort zone:

Are you in good health for traveling and volunteer work? Please explain if you have any medical conditions.

If you have any concerns or questions please mention here:

Do you have any referrals or discount coupons? If yes, please write the number code
By signing here, I acknowledge that I thoroughly read all Global Crossroad terms and conditions (please
visit for my internship placement. I hereby
agree on all the terms and conditions given by Global Crossroad, including the organization’s responsibilities, my
responsibilities, my liability waiver, and the termination conditions of my Internship program. I understand
everything that I have read, and I will fully abide by all of Global Crossroad’ terms and conditions.

Date:        /           /

Payment information:
I would like to pay my program deposit of USD 200.00 by using

             a)   Cheque (please attach with application)
             b)   Bank transfer (please fax the receipt)
             c)   Credit card (we accept VISA and Master only)

Card type (please check):      1) visa              2) Master

Card number:
Would you like pay your full amount by using credit card?

    a)   Yes
    b)   No

If yes please write USD= …………

Card Expiry date:

CBS number (last 3 digit number in the back of credit card) ____________

Card Holder name:


Date:          /     /

Official use only:



Departure date:


Name of Placement

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