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Global Health Immersion Program Application

2027 Global Health Immersion Program

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Traveler Information

Legal Name(Required)

First Last

Preferred name

Date of birth

MM slash DD slash YYYY

Cell Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Information

Emergency contact name

First Last

Emergency contact phone

Emergency contact email

College/university

Major or intended major

Class year

Transcript

Please upload an unofficial or official college transcript

Max. file size: 800 MB.

Short Response Questions

Why are you interested in participating in this Global Health Immersion Program?

How does this experience connect to your academic, career, or personal goals?

This program includes community health outreach, reflection, cultural immersion, group travel, and some independent beach/dinner time. What part of the experience interests you most, and why?

What concerns, if any, do you have about participating, and what support would help you feel confident?

Have you participated in any healthcare, public health, volunteer, service-learning, education, or community outreach experience before? If yes, briefly describe.

Program Readiness

Are you comfortable participating respectfully in communities that may be culturally or economically different from your own? Please explain briefly.

Are you comfortable following group safety expectations, staying with the group during required programming, and communicating clearly with program staff? Please explain briefly.

Are you applying with a friend, classmate, teammate, or roommate? If yes, please list their name/s.

Health and Dietary Information

Dietary restrictions

Allergies

Health, mobility, or medical considerations ILI Travel should know about to support your participation

Financial Acknowledgment

Please check each box:(Required)

I understand the program fee is $1,850 plus airfare.

I understand the $100 deposit is non-refundable.

I understand the payment deadlines are September 15 and November 15.

I understand the paperwork required for the travel waiver and photo release

I understand that airfare, two independent dinners, optional Monkey Jungle/ziplining, passport fees, travel insurance, personal spending money, and tips are not included.

I understand that scholarship credits are applied according to the published program policy.

I was referred by:

I referred:

Final Question

In a few sentences, what would make you a strong participant for this program?

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