Dominican Foundation, Inc.
5840 Red Bug Lake Road, Suite 280
Winter Springs, FL 32708

IDDI Summer Service Academy - July 16-August 2, 2007

First Name:
Last Name:
Address:
City:
State:	ZIP:
Country:
Home Phone:
Work Phone:
Email:
Date of Birth:
If you are a student, what university do you attend?
Year:	Freshman Sophomore Junior Senior Graduate Student
Any Additional Comments?
T-shirt Size:	Small Medium Large XL
Are you already or planning on fundraising for your program fee?:
Yes No
Do need help in receiving college credits with your university?	Yes No
*Would you like to be considered for a scholarship?	Yes No
*There are a limited number of partial scholarships that can assist students with the $2800 fee. If you are interested in being considered, please write a short 500 word essay explaining your interest in the Dominican Republic and the IDDI Summer Service Learning Academy. Please submit this essay with your application.
Signature:
Date:
**If you under the age of 18, please have a parent or legal guardian also sign this application form.
Signature:
Date: