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Personal Details:First Name:
Last Name:
Date of Birth:
Nationality:
Gender: Male Female Contact Details:E-Mail:
Street Address:
Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Telephone: Emergency Contact: Name:
Telephone:
E-Mail:
Preferred Work Areas for Placement: (please be as specific as possible on your cover letter) First Choice:
Second Choice:
Third Choice: Some examples of area choices are:
Language Details: What is your native language?
How do you rate your host country language skills? Native Beginner Elementary Intermediate Advanced
Do you speak any other languages? Yes No - If so, which?
Will you be doing the language course before your internship?
Package Information: (please select the services you require) Internship Internship placement (1100 Euros): Yes No
Name of city you would like to doyour internship:
Number of months you would like to do your internship for:
Date of commencement of internship? This date will be either 2 weeks or 1 month later than the beginning of your language classes
Finishing date? Resume and Cover Letter Translation Will you need your documents to be translated? (30 Euros/page) Yes No Arrival Retrieval Airport or Train Station pickup (75 Euros)? Yes No Arrival Information Arrival date:
Arrival time:
Origin of flight:
Flight number:
Airline: Accommodation:For options see Fees section Accommodation booking (75 Euros)? Yes No What is your choice of accommodation? Single room student apartment Deluxe studio Deluxe single room Deluxe double room
Date of arrival:
Date of departure: Insurance: Insurance (35 Euros/month for Spain),Number of months:
Insurance (55 Euros/month for Belgium),Number of months: Language course: Spanish course 2 weeks - Madrid - 40 classes (396 Euros): Yes No
Spanish course 4 weeks - Madrid - 80 classes (693 Euros): Yes No
Spanish course 4 weeks - Barcelona - 60 classes (360 Euros): Yes No
French course 4 weeks - Brussels - 80 classes (475 Euros): Yes No
Date of language course commencement(Monday)? TOTAL: Total price you need to pay Eurointerns:(not including actual accommodation costs) Euros Additional comments:
Other: How did you hear about Eurointerns?
If Internet, do you remember which site?
Will you have your own valid travel/medical insurancepolicy during the internship? Note: If yes, please send us a copy of the certificate.
Yes No
Name of insurance and policy number?
Terms and ConditionsTerms In consideration of Eurointerns, by accepting a work experience placement, youA. promise that all information given in the application is accurate and complete.B. agree:
_______________ I have read and agree to the Terms and Conditions.Please check the box _______________
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