Confirmation Form for New Add(s) - VAW Global Health Alliances

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Personal Information

Full Name*

First Last

Email Address*

Phone Number*

University/College*

VAW Global chapter (name & type)*

University of Washington - Seattle (UW Seattle) Medical

Virginia Polytechnic Institute and State University (Virgina Tech) Medical

University of Illinois Chicago (UIC) Medical

Santa Clara University (Santa Clara) Medical

Outreach Internship Verification

Type of Outreach

VAW Global Health Alliance’s high season is in the months of May and August, as well as from December 24-January 1.

1-week, regular season

1-week, high season

2-week, regular season

2-week, high season

Confirm your VAW Global's internship outreach (1-week, regular season)*

Attached to each option is the link to the Upcoming internship page of the chosen chapter.

University of Illinois Chicago (UIC) Medical, Panama (Mar 19-26, 2022)

Confirm your VAW Global's internship outreach (1-week, high season)*

Attached to each option is the link to the Upcoming internship page of the chosen chapter.

University of Washington - Seattle (UW Seattle) Medical, Guatemala (Dec 23-30, 2021)

Confirm your VAW Global's internship outreach (2-week, regular season)*

Attached to each option is the link to the Upcoming internship page of the chosen chapter.

Santa Clara University (Santa Clara) Medical, Guatemala (Jun 16-30, 2022)

Confirm your VAW Global's internship outreach (2-week, high season)*

Attached to each option is the link to the Upcoming internship page of the chosen chapter.

Virginia Polytechnic Institute and State University (Virgina Tech) Medical, Guatemala (Dec 28-Jan 11, 2022)

Confirm the leading VAW Global chapter's name (1-week, regular season)*

Attached to each option is the link to the Empowered page of the chosen chapter.

UIC Medical, Panama, Mar 2022

Confirm the leading VAW Global chapter's name (1-week, high season)*

Attached to each option is the link to the Empowered page of the chosen chapter.

UW Seattle Medical, Guatemala, Dec 2021

Confirm the leading VAW Global chapter's name (2-week, regular season)*

Attached to each option is the link to the Empowered page of the chosen chapter.

Santa Clara Medical, Guatemala, Jun 2022

Confirm the leading VAW Global chapter's name (2-week, high season)*

Attached to each option is the link to the Empowered page of the chosen chapter.

Virgina Tech Medical, Guatemala, Dec 2022

Country and dates confirmation*

You are welcome to check "the Upcoming Outreach Internship page" and join any team with available spots as an individual intern. (Note: dates could fluctuate +/- 3 days depending on airfare cost.)

I understand the country and dates my team has chosen.

Team Development Coordinator (TDC)

For any questions and/or concerns, please direct your emails to the TDC for specific trip questions, including flights and general questions.

Ngoc Le*

ngoc.le@vawglobal.org

ChhengAn Ul or (An U.)*

an.chheng@vawglobal.org

Team Development Team (PILOT)*

teamdevelopment@vawglobal.org

Internship cost

VAW Global Health Alliance’s high season is in the months of May and August, as well as from December 24-January 1. If any of a team’s trip days fall within that range, the high season program fee applies. By picking a choice for each of the field below, you confirm that you understand the costs involved with this trip and are ready to make the financial commitment.

Program fee (1-week internship, regular season )*

$990

Program fee (1-week internship, high season)*

$1040

Program fee (2-week internship, regular season )*

$1795

Program fee (2-week internship, high season )*

$1895

Medication & supply fund fee (1-week internship)*

$50

Medication & supply fund fee (2-week internship)*

$100

Airfare*

Variable

Financial Commitment

Deposit Schedule Commitment*

Attached to name of your VAW Global's internship outreach in the verification question above is the link to the Tentative deposit schedule of the chosen internship outreach. And, it is important that you stay up to date with your payment.

I understand the deposit schedule and am committed to completing the payments on time.

First deposit confirmation*

The first deposit is $250 and is non-refundable and non-transferable, but may be able to be applied to future VAW Global trips.

I understand that $250 deposit is not refundable nor transferable to another intern, but could be used to travel with another Chapter on different dates.

Payment method for First $250 deposit*

Immediately, via website's Paypal

Later, via Empowered page

Insurance: Cancel for Any Reason*

I understand that is my responsibility to purchase the Cancel for Any Reason Insurance within the next 14 days of when the spot deposit has been made to protect my funds.

Participation Commitment

To be well prepared for this amazing experience, it is very important that you attend your team's meetings, read through the documents provided by VAW Global and read every email sent to you. You will get out of this experience what you put into it, so it's important for YOU to take personal responsibility for preparing yourself.

Responsibilities*

I understand that I will need to take personal responsibility for preparing myself for this trip, and I am ready to be a positive contributor to my team.

Terms and Conditions*

I have read and agree to the Terms and Conditions of VAW Global Health Alliances.

Release and Waiver*

I have read and agree to the Release and Waiver of VAW Global Health Alliances.

Make First Deposit

Deposit 1 ($250) to secure your spot on a trip*

The deposit is $250 and is non-refundable and non-transferable, but it can be applied to future VAW Global trips if you withdraw from the trip more than 6 months before the trip departure date.

Price:

Payment Method*

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Comments

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