Volunteer Application

Please submit the form below or click here to download a printable form to submit by email to Info@resolute.health.

Personal Information

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Volunteer Questions

What is your area of expertise / profession?

How long have you been working in this field?

Have you traveled outside the U.S.?

Other skills or languages?

Domestic volunteer experience:

International volunteer experience:

Do you have any physical limitations?

Have you ever been convicted of a felony? If so, please explain:

in 150 characters (or less) tell us why you're interested in RHO?

Travel Questions

Select travel availability

We are planning our next medical mission. Please indicate your availability by choosing a week or weeks that work best with your schedule. (select multiple weeks if you plan to stay for two weeks, or overlap).

Week one : Feb 24th - Feb 28th, 2020

Week two : March 2nd - March 6th, 2020

Please indicate your exact preferred departure and return dates and city:

Departure airport city:

Departure Date

YYYY

Return Date

YYYY

RHO can only book travel through Ethiopian Airlines. Would you like RHO to book your travel for you?

Yes

No, I can book my own travel.

Where would you like to stay?

During previous trips to Ethiopia, participants have stayed at the Embilta hotel. It is safe, free, and within walking distance to SPHMMC (driver also available). Participants working at Black Lion require a driver. However, we care about your safety and comfort. Where would you like to stay in Addis?

Do you have any dietary restrictions?

Passport Number

This form is secure and confidential and will only be used for purchasing tickets and in the event of an emergency.

Date Issued

YYYY

Expiry Date

YYYY

Date of Birth

YYYY

Emergency Contact Information

Contact's Name

First Name

Last Name

Contact's Phone Number

(+1 is the country code for USA and Canada)

Country

(###)

###

####

Relationship to you: