NWB-Thailand Global Citizen Program Application
Email Address *
Gmail preferred
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Trip dates: *
Please note we cannot guarantee that we can accommodate your desired dates.
Full Name *
Your answer
Phone Number *
Include country code if outside of the US
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Gender
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Age *
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Address *
Street, City, State/Province, Postal/Zip Code, Country
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Passport Number, Country, Expiration
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I acknowledge that I must upload my passport if I have not previously done so. *
Please use the document upload below.
Emergency Contact Info
Emergency Contact's Full Name *
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Relationship to You *
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Emergency Contact's Address *
Street Number, City, State/Province, Postal/Zip Code, Country
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Emergency Contact's Phone Number *
Include country code if outside of the US
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Emergency Contact's Email Address *
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Have you volunteered with NWB before? If so, where/when? *
Your answer
Please describe your interest in Naturopathic Global Health. *
Your answer
Why did you choose NWB's Global Citizens Volunteer Program? *
Your answer
Please describe any work or volunteer experience you have in a developing country and/or with underserved populations. *
Please include where you volunteered, when, with whom (organization/population, etc) and what you did.
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Please list your formal education, beginning with your undergraduate university. *
Be sure to include the name and location of the university, dates you attended, your course of study, the degree you earned and any relevant honors and extracurricular activities you engaged in while attending. You may also include any certificates you have earned.
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If you have any clinical experience, please describe it below including the name and location of the hospital or clinic, the type of experience and the specialty you practiced.
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Please describe any skills you have which may be assets to NWB-Thailand. *
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What do you expect to contribute during this experience? *
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What do you expect to gain during this experience? *
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What are your hobbies? *
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How did you find out about NWB's Global Citizen Program in Thailand? *
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Participant Level *
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