Global Health Immersion Program Application 2027 Global Health Immersion Program Step 1 of 7 14% InstagramThis field is for validation purposes and should be left unchanged.Traveler InformationLegal Name(Required) First Last Preferred nameDate of birth MM slash DD slash YYYY Email Cell PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Emergency Contact InformationEmergency contact name First Last Emergency contact phoneEmergency contact email College/universityMajor or intended majorClass yearTranscriptPlease upload an unofficial or official college transcriptMax. file size: 800 MB. Short Response QuestionsWhy 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 ReadinessAre 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 InformationDietary restrictionsAllergiesHealth, mobility, or medical considerations ILI Travel should know about to support your participation Financial AcknowledgmentPlease 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 QuestionIn a few sentences, what would make you a strong participant for this program?Frequently Asked Questions (Page will open in a new tab) {{#message}}{{{message}}}{{/message}}{{^message}}Your submission failed. The server responded with {{status_text}} (code {{status_code}}). Please contact the developer of this form processor to improve this message. Learn More{{/message}}{{#message}}{{{message}}}{{/message}}{{^message}}It appears your submission was successful. Even though the server responded OK, it is possible the submission was not processed. Please contact the developer of this form processor to improve this message. Learn More{{/message}}Submitting…