Emory VAW Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in joining VAW at Emory! As a team member, you will have the opportunity to shadow medical professionals, work side by side with experienced doctors, perform triage, manage the pharmacy, and teach public health classes to children or teenagers. You will also have free time to travel in the host country, experience a new culture, and build amazing relationships! We are looking for committed participants who will go above and beyond to make this a memorable experience for everyone involved.

Name *

Will you be at least 18 years old by May 2019? *

Yes

Year in School *

Freshman

Sophomore

Junior

Senior

Other:

Email *

Phone Number *

Majors/Minors/Track

How did you hear about VAW? *

Facebook

Flyers

Email from Department

Pre-Health Mentoring Office

Friend

Required

Will you be able to commit to fundraising activities and occasional (1/month) meetings? *

Yes

Are you interested in leadership positions? *

Yes

Maybe

So you are aware, the cost of this program include: program fee ($1650-1750) + medicine fund ($100) + airfare (around $900-1000). We will fund-raise and usually fundraising will cover the medicine fund and a little bit of program fee. Thus, the total cost of this trip will be around $2650. Please confirm you have enough fund to support you to participate in this trip. *

Do you have any limitations for dates? The trip lasts 2 weeks in the summer. (summer classes, internships, other plans, etc.) *

We have a combined trip of Emory University and Augusta University available right now. It is to Panama from May 31st to June 14th. Some Emory students have already confirmed to participate in this trip. Are you okay with the date and location of this trip? *

Yes, I am okay with the dates and location and I would like to participate in this trip.

No, I have schedule conflict and cannot participate in this trip. But I am willing to join other schools and participate in other VAW trips.

No, I have schedule conflict and cannot participate in this trip. I will only participate in the trip of Emory (this will only happen if people who have confirmed decided to change dates together).

If you cannot join the Emory trip and want to participate in other trips, which location are you most interested in? *

Cambodia

Dominican Republic

Guatemala

Panama

Vietnam

I will participate in the Panama trip mentioned above.

Why are you interested in attending this medical outreach trip?

What would you like to get out of this trip?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms