Visa Application Form

This is a secure form. Once you have started entering your information, please do not navigate away from the page until you have completed and submitted the form. The form will not save your information, and we don't want you to have to enter it more than once!

Full Name (as indicated in your passport)*
First Middle Last
Title*
- Mr.
- Mrs.
- Miss
- Ms.
- Dr.
- Prof.
- Rev.
Previous Maiden Name(s)
Home Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Email*
Primary Phone Number*
Mode of Communication*
- Text
- Email
- Text & Email
Mobile Number*
Name & Address of Work/School/Business in Canada*
Name Address City State / Province / Region ZIP / Postal Code Country
Occupation/Profession*
Gender*
- Male
- Female
Marital Status*
- Single
- Married
- Widowed
- Divorced
Place of Birth*
Nationality*
Nationality at Birth*
Other Nationality
Financial Mode*
- Cash
- Card
- Cash & Card
Financial means at your disposal*
Have you ever visited Ghana before?*
- Yes
- No
Date of last visit to Ghana*
Have you ever been refused a visa to Ghana?*
- Yes
- No
Have you ever been refused any entry to Ghana?*
- Yes
- No
Do you have a criminal record in Ghana or any other country?*
- Yes
- No
Do you suffer from a mental disorder?*
- Yes
- No
Do you suffer from any communicable diseases?*
- Yes
- No
Please upload a copy of your yellow fever certificate*
Please upload a copy of your recent colour passport-size photograph (taken within six months of date of application)*
Phone
This field is for validation purposes and should be left unchanged.

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GRID Canada
PO Box 1208, Uxbridge Stn Main, ON L9P 1N5
tel: 289-429-1099
e-mail: grid@grid-nea.org

GRID USA
3204 Kristen Ct., Bloomington IN 47401
tel: 812-339-7399
e-mail: kbayless@grid-nea.org

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