ADDRESS:


PHONE NUMBERS:

Preference?
Medical-DentalConstruction




Have you previously applied for a Washington Overseas Mission Trip?
YesNo

Are you a Health Occupations student or taking advanced science courses with an interest in the medical field?
YesNo

Do you speak Spanish or are you a Spanish student?
YesNo

If yes, number of years?

Level?
FluentCan make self understoodLittleNothing

Have you ever volunteered for Washington Overseas Activities?
please select all that apply. Indicate approximate number of times if you have helped several times
Beans and Rice Ball fundraiser
Containers/Shipments
Storage Unit Organization Days
Rummage Sale

Are you related to, or have close ties to anyone who has actively supported and/or participated in WOM activities?
YesNo

If yes, list contact name and relationship: