Pagaea Partnership

Before filling out this application, please make sure you have read the program information page on this website. Click the box below to indicate that you have done so.	Yes, I have read all related program information and understand what this Summer Immersion Program includes and what my responsibilities are.
Name:
Last Name:
Email Address:
Date of Birth: (mm/dd/yyyy)
Primary Phone Number:
Address (line #1)
Address (line#2)
City:
State:
Country of Residence:
Zip Code:
Country of Citizenship:
Do you have a valid Passport?	Yes No
If so, what is the expiration date?
University Attending/ Attended
Field of Study / Intended Major
Date of Graduation
Are you applying as:	An Individual With Friends
If with you are applying with friends, please list their first and last names below.
What do you hope to learn on from the Pangea Immersion Experience? (500 words or less)
What do you hope to achieve from this Pangea Immersion Experience? (500 words or less)
Please describe your relevant skills, interests, or experience that you bring to this program. (1000 words or less)
Is this your first experience traveling to a foreign country?	Yes No
Are you comfortable working in a team atmosphere? If yes, please give us some examples of group work you have done in the past. (500 words or less)
Please tell us why you are interested in learning about and volunteering in South America and Sub-Saharan Africa . (500 words or less)
Please tell us why you are interested in learning about and volunteering in South America and Sub-Saharan Africa . (500 words or less)	Peace Building Public Health Poverty and Related Social Issues Education / Illiteracy Abuse & Family Issues Public Infrastructure & Architecture Environmental Conservation OTHER
Please list any medical conditions you have:
Please list any medications you are currently taking or will be taking during this trip
Please List any Allergies you have: (answer "none" if this doesn't apply to you)
Please list any dietary restrictions you have: (answer "none" if this doesn't apply to you)