Board of Directors

School*

Grade*

Name/Ages of Siblings*

Street Address/ PO Box*

Street Address 2

Town*

State*

Zip*

Student's Phone Number*

First choice to visit*

—Please choose an option—NicaraguaCambodiaTanzaniaNepalMorocco

Second choice to visit

—Please choose an option—NicaraguaCambodiaTanzaniaNepalMorocco

Foreign Countries Visited*

Pick a Date For Interview*

—Please choose an option—Oct 9thOct 10thOctv 11th

What Time for Interview

You will be notified of your confirmed interview time after we receive your essay.

Name of Parents/Legal Guardians*

Guardians Phone Numbers*

Guardians Emails*

Best Person and Method to Contact*

If you have traveled with us on a service trip in the past, are you interested in being considered as a student for 2016?

YesNo