Application for CBPHC Jamkhed trip
Thank you for your interest in the CCIH trip to visit the Comprehensive Rural Health Project in Jamkhed, India for hands-on learning and information sharing about community based primary health care.
Applications are due by October 23, 2018 and you will be notified by November 30, 2018.

Participants are expected to:
Be a current CCIH member.
Have prior experience in global health, especially community health.
Pay their $850 to CCIH by bank transfer, wire transfer, check, or credit card by January 5, 2019.
Book their flight by January 5, 2019 and send their flight information to mona.bormet@ccih.org.
Participate in 1 pre-trip call to prepare and 1 post-trip call to de-brief.
Write a summary of their experience for CCIH’s monthly newsletter, the website, and/or social media purposes.
Share photos and give consent to use of photos by CCIH and CRHP.
Be interested in CBPHC and in learning from community members.

First Name *
Your answer
Last Name/Surname *
Your answer
Organization *
Your answer
Title *
Your answer
Address *
Your answer
Country *
Your answer
Gender *
Your answer
Are you an individual or organizational CCIH member? *
How did you hear about the trip? *
Why do you want to participate in this trip? What is your current role at your organization? What do you hope to learn from CRHP? *
Your answer
What specific area of focus are you most interested in?
Who is sponsoring your trip? *
Submit
Never submit passwords through Google Forms.
This form was created inside of Christian Connections for International Health. Report Abuse - Terms of Service - Additional Terms