COVID-19 Information


Deadline: 11:59 pm on Wednesday, October 30, 2019

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*:





Cell phone*:

What roles are you willing to be responsible for?


During the 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.