Global H.E.E.D.| Health, Education, and Economic Development

March 21, 2008 - Chief Operations Officer Ankush Sharma represents Global HEED at President Clinton's Global Initiative University Read Article | March 20, 2008 - Chief Operations Officer Ankush Sharma to attend Clinton's Global Initiative University Read Article at http://www.news.harvard.edu/ | January 30, 2008 - Founder of Global HEED, Zain Ahmed, receives 2008 Humanitarian Award Read Article at http://news.emory.edu or http://emorywheel.com | September 12, 2006 - Emory Wheel describes Global HEED's (formerly known as Emory Humanitarians) trip to Guatemala Read Article at http://emorywheel.com |

Global HEED Summer 2010 Nepal Trip Application

Directions: Please complete the following information and submit the application using this page. You will be able to review and print the application before the final submission. The application is due April 30, 2010 and applicants will be notified of their status two to three weeks after submission. Only 20 spots are available. Application is on a rolling-basis so the earlier you apply the better your chances. A non-refundable deposit of $600 is due two weeks following acceptance in order to secure a spot on the trip. The trip cost is to be determined, but it will include housing, food (breakfast, lunch, dinner), in-country transportation and logistical fees. If you have any questions or for more information, please contact us at contactus@globalheed.org.

Personal Information
Full Name (as it appears on passport)
E-mail Address
Current Address
Permanent Address	Same as current address
Campus P.O. Box
Home Phone		Cell Phone
Are you a US citizen?	Yes No	If No, please list your nationality
Gender	Male Female	Date of Birth
School & Year in School	If Faculty/Staff/Alumni/Other (see Professional Information)
Current Concentration/Major/Minor (if applicable)

Emergency Information
Please include two contacts who can be notified in case of an emergency
Name #1
Home Number		Work Number
Relationship

Name #2
Home Number		Work Number
Relationship

Please list any medical conditions that we should be aware of (medications, allergies, etc)

Professional Information
Current job title
Business Address
Business Phone
Business E-mail

Questions
Please rank the following trip dates in order of preference by entering a number next to the dates. If you are unable to attend a specific session, please leave its textbox blank.
June 19 - July 10 July 17 - August 7
Why do you want to volunteer in Nepal?

Describe some of your previous international experiences. Have you volunteered in a developing country before? If so, please describe your experience (your initial impression, what you did, length of stay, your final impression, etc). If you haven't, please describe some of your expectations of this trip.

What will you be able contribute to the dynamics of the group? Describe any health-related and/or nonhealth-related talents or skills that you might posses.

Do you speak Hindi or Nepali? If so, please describe fluency.