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
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? *
Never submit passwords through Google Forms.
This form was created inside of Christian Connections for International Health. Report Abuse - Terms of Service - Additional Terms