LAUGHH Volunteer Application
Complete this form if you are interested in being a volunteer at a LAUGHH Mission. (ALL volunteers will use this application.) Please apply ASAP! Applications will be open to all volunteers on November 3, 2018 and will close on January 15, 2019. Please understand that submission of this form does not guarantee your selection for this year's mission. Selections will be announced no later than March 9, 2019.
Email address *
I have read and understand the Mission Announcement and details of the 2019 Mission. *
Required
PERSONAL INFORMATION
Name as it appears on your passport *
Your answer
Suffix(es) to your name: (MD, RN, PA, NP, etc.)
Your answer
Country of passport *
Your answer
Date of birth *
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/
DD
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YYYY
Date Passport Expires *
MM
/
DD
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YYYY
Passport Number *
Your answer
Does your Passport expire 6 months AFTER the mission dates? (If "No", be advised that you will need to provide us the renewed Passport information ASAP.) *
Is your passport valid and without restrictions for travel to any of our mission communities? *
Please explain if there are restrictions, etc. on your passport.
Your answer
Name or nickname which should appear on your nametag: *
Your answer
Home Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Cell Phone *
Your answer
EMERGENCY CONTACT INFORMATION
(This needs to be a Relative, Neighbor or Friend NOT with you on the mission.)
Name: *
Your answer
Street Address: *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Phone: (Please indicate if it is Cell, Home or Work Phone number. Please provide the best way to contact the person.) *
Your answer
Email address: *
Your answer
Relationship to volunteer: *
Your answer
EMPLOYMENT INFORMATION
If you are retired, please check "Yes" and move forward to the LANGUAGE PROFICIENCY section.
If you are NOT retired, please check "No" and answer ALL of the employment information.
If you are a student, please check "No", and answer the information as indicated.
I am retired. *
Current Employer/Name of school:
Your answer
Number of years employed/Year in school:
Your answer
Work address/School Address:
Your answer
Your current position/job title/Field of study:
Your answer
Profession and specialties (if applicable):
Your answer
LANGUAGE PROFICIENCY
Spanish *
Required
PREVIOUS VOLUNTEER EXPERIENCE
Have you previously applied to a LAUGHH Foundation, Inc. mission? *
If "Yes", please indicate year(s):
Your answer
Have you been a team member on another International Health Team? *
If "Yes", please give details (year(s), organization(s), service you provided)
Your answer
Are you currently, or have you recently been involved in any local volunteer commitments to those who are poor? *
If "Yes", please give details (year(s), cities & countries, type of work)
Your answer
PERSONAL HEALTH STATUS
Please be mindful of being in a very demanding environment. Working in a developing country can present a strenuous and stressful environment. Teams work LONG DAYS with only a short break for lunch. Sleeping environments are clean and adequate, but may not be very quiet.
Are you physically fit and free of medical conditions or disabilities that could limit your activities and/or prevent you from safely performing the volunteer services for which you are applying? *
If "No", please give details.
Your answer
Do you have any dietary restrictions, such as allergies, vegetarian, vegan, etc.? *
If "Yes", please give details.
Your answer
Please list known ALLERGIES (medications, food, insects, etc.) *
Your answer
Please list all current Medications: *
Your answer
Motion Sickness: LAUGHH teams may travel on rough and winding roads to get to remote sites. It is important for us to know any volunteer who may have a problem with motion sickness. Do you have any problems with motion sickness? *
If "Yes", please explain what prevents or helps mitigate the problem.
Your answer
PERSONAL MOTIVATION
New Volunteer: How did you hear about the LAUGHH Foundation, Inc.?
Your answer
New Volunteer: In 200 words or less, describe your desires and reasons for participating in the LAUGHH Foundation, Inc.'s Medical Mission Program.
Your answer
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