Remember Me
Name (as on passport, including middle name)*
ADDRESS:
Street Address 1 * Street Address 2
City *
State *
Zip *
PHONE NUMBERS:
Home
Cell
Email Address *
Name of your school *
Current Year of Study *
Medical Information (Allergies, medical problems, etc.)
In Case of Emergency, Notify (name, address, phone, relationship):
Preference? Medical-DentalConstruction
How did you find out about this trip?
Have you previously applied for a Washington Overseas Mission Trip? YesNo
If yes, when?
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 Other -- please list
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:
Application Essay Please answer the following questions in a one to two page typed essay: Why should I be considered for the trip? What special talents do I bring to the group? How did you learn about this experience?
