Ghana Health Partners November 2023 Application

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Ghana Health Partners Application November 2023

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 Country
Email*
Primary Phone Number*
Alternate Phone Number
Previous 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.
Are you currently a licensed medical professional ?*
- Yes
- No
What 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 from the previous one you submitted last year no need to upload)
What is your current occupational/professional role?
If you are retired, please share your most recent role.
Professional and Education Update
Please 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?
When does your passport expire?*
- I don't have a passport
- It expires BEFORE May 31, 2024.
- It expires AFTER May 31, 2024.
Passport 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 by September 11, 2023.
- I agree that I will renew my passport before Monday, September 11, 2023.
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 September 11, 2023.
- I agree that I will obtain a valid passport by Monday, September 11, 2023.
How would you describe your general health?*
- Excellent
- Good
- Fair
- Poor
Do you take any medications?*
- Yes
- No
Please list the medicines you are taking.
Do you have any known allergies?*
- Yes
- No
Please 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.*
Comments
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