APPLY NOW — VOLUNTEER MOROCCO

APPLY NOW

Volunteer Morocco Service Learning Trip

INFORMATION and NOTIFICATION FORM

Interested students should complete this application and once reviewed for basic qualifications, are accepted to the program on a first-come, first serve basis

PLEASE INDICATE WHICH TRIP YOU ARE INTERESTED IN:

May 2024 (Global Health)

May/June 2024 (Global Health - Ophthalmology focus)

December 2024/2025 (Global Health)

Name

Passport Number

Country Where Issued

Date of Birth

YYYY

Gender

Male

Female

Major

Graduation Year

Email Address

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Health Insurance Policy Name & ID Number

Please check on your health care coverage. It is your responsibility to check with your insurance company to make sure you are covered when abroad.

EMERGENCY CONTACT

Emergency Contact Name

First Name

Last Name

Relationship

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Cell Phone

(###)

###

####

Contact Home Phone

(###)

###

####

Contact Email Address

Please give a brief summary of why you want to volunteer in Morocco.

Please briefly explain any medical training you have or medical work you have done.

Please indicate how many hours per day you would like to volunteer while on the trip. (there is no "right answer".

INFORMATION and NOTIFICATION FORM

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