Apply!

Program only offered to first year Geisel Medical students and TDI students

Entries marked with * are required.

Personal Information
Legal Name*:	(as it appears on your ID)
Date of Birth*:
Gender:	Female Male
Affiliation*:	Medical Student TDI Student
Address*:
Email*:
Cell phone*:
What roles are you willing to be responsible for?
Pre-Trip:	Develop/Organize the Elective Develop Service Opportunities Organize Fundraising Coordinating Gifts Public Relations Budget Coordination Organize Fingerprinting/Background Checks
During the Trip:	Blogger/Public Relations Trip Leaders Photographers Expense Coodinator
Post-Trip:	Prepare Presentation to Medical School Community Coordinate Trip Report Send Thank You Cards
Please answer the following questions
Please describe your leadership or community service experiences and what you learned from them*:
What have been your experiences with diverse cultures and languages?*:
How can you contribute to this trip, would you be willing to help out with the planning process?*:
Are you a certified Dartmouth College driver?*:	Yes No
If not would you be willing to become certified?:	Yes No
If you have any questions please contact Shawn O'Leary.