Full Legal Name*
Nickname
Age*
Birthdate*
Passport Expiration Date
Passport Number*
If you don't have a passport, please type "Need to apply" in this box
School*
Grade*
Name/Ages of Siblings*
Mailing Address
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
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
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