Medical Missions Application

First and Last Name(required)

Email(required)

Phone Number(required)

Street Address/City/State or Province/Postal Code/Country(required)

Date of Birth(required)

Sex?(required)

Outreach trip applying for?(required)

T-Shirt size?(required)

Have you been on a foreign mission before?(required) Yes

No

If so, where and how long? (Maximum 200 words)?

Are you willing to refrain from smoking and/or drinking alcohol while participating on this outreach?(required) Yes

No

Are you willing to work in an unsterile outdoor work environment?(required) Yes

No

Do you work well as part of a team with different personalities?(required) Yes

No

Are you willing to wake up early and go to bed late several days in a row?(required) Yes

No

If your application is approved, do you have the necessary funding for the trip ?(required) Yes

No

If not, what are you planning to do to raise the funds(Maximum 500 words)?

Do you have any dietary limitations, such as diabetic, vegetarian diet etc. or any food allergies? If so, please explain(If not applicable, write N/A).(required)

Please list any health conditions that we should be aware of, as well as, any prescriptions medications you are taking for these conditions(If not applicable, write N/A).(required)

Why do you feel you should be involved in this U-VOL Foundation Missions/Outreach Trip?(limit 200 words)(required)

What is your profession?(limit 50 words)(required)

What is your specialty?(limit 50 words)

How many years of experience do you have in your profession? If you are not a medical/healthcare professional, choose N/A.(required)

Are you currently working in your profession?(required) Yes

No

Retired

Other

Do you attend church?(required) Yes

No

If so, what is the name of your church?

How did you hear about us?(required)

Other Details

If I am selected to go on a U-VOL Foundation(UVOLF) outreach, I agree to book my flights only through the UVOLF approved travel agent. I understand that booking travel to and from an outreach on my own is not an UVOLF approved travel option and may result in me being removed from going on the outreach. I agree that I am responsible for any fees or penalties to cancel travel booked outside of the UVOLF approved travel agent.?(required) Yes

No

U-VOL Foundation reserves the right to conduct a background check. Are you willing to submit to a background check if requested?(required) Yes

No

I agree to U-VOL Foundation Privacy Policy(required) Yes

No