Team Application Form

Please fill out the application below to be considered for an upcoming team. Make sure you identify which team you are interested in traveling with. You may only apply for one team per submission.

NOTE: Passports must be obtained prior to departure. Once you have obtained a passport, please email a color scan of your passport to the Operations Coordinator: Monica C.Holgen:   monica@projecthelpinghands.org

Team Applying For:
Contact Information:
Must match passport
Must match passport
Must match passport
Gender:
Address where you can receive mail and packages
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Passport Information
Are you a United States citizen?:
Do you have passport information yet?:
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Preferred Airport of Departure (Must be major USA Hub airport and not a regional airport)
Professional Information
CV or Resume:

You may scan and email to monica@projecthelpinghands.org is you are having difficulty uploading your resume This information is required for medical professionals.

Emergency Contact Information

Physical limitations or medical conditions:

For medical and licensed professionals only
Is your professional license current and active?:
If yes, is your license unencumbered?:
Has your license ever been suspended or revoked?:
Copy of medical/dental license:

VERIFICATION

Please make sure that you have checked over all of your information in the above form and that it matches the information on your passport. Airline tickets will be based off of this information and any errors submitted may result in additional costs at the applicant's expense. Check this box to verify that your information is valid and that you are aware of the consequences that may ensue if information is incorrect.

 

Please note: There is a $300 Deposit due when you submit this application. If selected as a team member this fee will be applied as a donation toward your trip and is non-refundable. In the event that you are not selected for this team you have the option of either a refund of the full donation, you can apply this donation toward another PHH trip or you can donate these funds to the PHH general fund. Once you submit this application, you will be directed to our donation page. Be sure to select the trip you are applying for from the pull-down menu under "Please direct my donation to:"

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