African Promise Expeditions Application

Today's Date

MonthDayYear

Name as shown on Passport

PrefixFirst NameMiddle NameLast NameSuffix

Name You would like to be called

First NameLast Name

Date of Birth

MonthDayYear

Age

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

T-shirt Size

XS, S, M, L, XL, XXL, XXXL

Cell Phone

Area CodePhone Number

Home Phone

Area CodePhone Number

E-mail

Trip you are applying for: Dr. Julie Hanks June, or July Dare to Lead

Airport you will be departing from and returning to [home]

Name on Passport, Passport Number, Expiration date

Country your passport was issued in

Hobbies/Interests

Areas of Interest (teaching, sewing, art, carpentry, music,sports, etc.)

Emergency Contact (name, email, phone number)

Relationship of person listed above

Please list any medical conditions you have that may restrict your activities

Allergies

Please list any medications you take regularly

Please list any special dietary needs you have

II. As you answer the following questions, please remember there are no right or wrong answers; we simply want you to have the best experience possible. Please complete all of the questions. If a question does not apply to you then mark N/A in the space provided. Feel free to keep answers brief but informative.

1. Why are you interested in a personal development journey? Why Africa?

3. Have you traveled overseas before this? Where, when and what were the circumstances?

4. Describe your mostrewarding and your most frustrating volunteer experience.

5. If you are in asituation where no one seems to know what they are doing, do you tend to leadout, or are you comfortable waiting for someone else to jump in?

6. Traveling to and within Africa can at times involve stressful and/or unpredictable situations. Please describe how you have reacted to stressful and/or unpredictable situations in the past.

III. Please complete the following sentences: (please be candid!) What I find most appealing or exciting about this kind of experience is...

What frightens me the most about this kind of experience is:

My greatest strength that will help me in this work is:

My greatest weakness that will challenge me in this work is:

IV. Please describe what you hope to learn from this experience, what you hope to contribute and what you hope to accomplish.

Learn:

Contribute:

Accomplish:

Signed:*

Date*

MonthDayYear

Signature of Legal Guardian:

Date

MonthDayYear

Print name of Legal Guardian

First NameMiddle NameLast Name

Thank you for your interest in African Promise Expeditions' work in Uganda. We will do our best to review your application within 14 days.