Ghana Health Partners 2025 Application Ghana Health Partners Application 2025 This is a secure form. Once you have started entering your information, please do not navigate away from the page until you have submitted your application. The form will not save your information, and we don't want you to have to enter it more than once! Name (as it appears on your passport)* First and Middle Names Last Home Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Primary Phone Number*Alternate Phone NumberPrevious Team Membership*Have you been on an previous GRID-NEA Ghana Health Team/Ghana Health Partners mission? Yes, I am a returning member. No, this is my first time volunteering. Which of these mission dates will you be joining?* February 8-16, 2025 (In-Country Dates) April 26-May 10, 2025 (In-Country Dates) November 8-22, 2025 (In-Country Dates) Are you currently a licensed medical professional ?*YesNoWhat is your medical speciality?*Medical professionals, please attach a copy of your current license. (ONLY if you have an updated license. If it's the same one from your previous application, no need to upload)What is your current occupational/professional role?If you are retired, please share your most recent role.Professional and Education UpdatePlease tell us about any professional changes that you have experienced since last joining the Ghana Health Team/Partners. Have you pursued additional training? Has your professional role changed at all?Does your passport expire within 6 months of the mission's last day?*YesNoPassport Update Needed*Travel visas to Ghana cannot be issued if your passport expires within 6 months from the last day of the mission. Your passport expires before that deadline. Please confirm that, should you be accepted, you will renew your passport at least two months before your departure date. I agree that I will renew my passport at least two months before my departure date. Please provide a copy of your passport. (ONLY if you have renewed or applied for a new passport from the time of your last application)Passport Needed*Please confirm that, should you be accepted to the team, you will secure a valid passport by December 8, 2024. I agree that I will obtain a valid passport by Monday, December 8, 2024. How would you describe your general health?*ExcellentGoodFairPoorDo you take any medications?*YesNoPlease list the medicines you are taking.Do you have any known allergies?*YesNoPlease list your allergies.Dietary Restrictions*Our hosts in Ghana can provide vegetarian options; however, if you have other dietary restrictions, you will need to pack your own food for two weeks.I have no dietary restrictions.Vegetarian: I understand that NEA can provide limited vegetarian options.Other (vegan, gluten-free, dairy-free, nut-free, etc.): I understand that NEA cannot accommodate my diet and agree to pack appropriate food and/or supplements for the two weeks.Additional Information (Optional)You may use this space to share any additional information about yourself.Confirm that you understand GRID and NEA's Christian foundation.*GRID and NEA are Christian organizations. Volunteers are not required to be Christians, but must be willing to work as part of a team defined by Christian goals and values. I understand that GRID and NEA are Christian organizations, and I am willing to work as part of a team defined by Christian goals and values. Confirm that you understand and accept the expectations of Ghana Health Partners Team Members.*Please read the Expectations of Ghana Health Partners Team Members. I have read the Expectations of Ghana Health Partners Team Members and am willing to abide by them. Confirm that you understand and accept the Volunteer Agreement, Security & Safety Guidelines and Waiver & Release.*Please read the Volunteer Agreement, Safety & Security Guidelines and Waiver & Release. I have read the Volunteer Agreement, Safety & Security Guidelines and Waiver & Release and I am willing to abide by them. Please upload a copy of the signed Volunteer Agreement and Waiver & Release.*EmailThis field is for validation purposes and should be left unchanged. Δ
