Apply!

Deadline: 11:59 pm on Sunday, October 21, 2018

Program only offered to first year Geisel Medical students

Entries marked with * are required.

Personal Information

Legal Name*:

(as it appears on your ID)

Date of Birth*:

Gender:



Address*:

Email*:

Cell phone*:

What roles are you willing to be responsible for?

Pre-Trip:








During the Trip:





Post-Trip:




Would you like your name added to the class roster for the MNIHST Elective?*:



Please Note: You can only register for two electives at a time. If you are participating on the trip, you will still be required to attend all pre-trip sessions.

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?*:



If not would you be willing to become certified?:



If you have any questions please contact Shawn O'Leary.