Thank you for your desire to serve through Project Humanity on this international project! This vital step of applying for service is an important one, and we welcome you to the journey of serving others.

Please carefully read each of the statements below as you share your information with us. At any time in the application process that you have questions, please feel free to contact us at 678-431-0680.

Again, thank you for your interest in serving! We look forward to this journey with you!

Personal Information:
	Your name as it appears on your passport:
	First Name:	Middle Name:	Last Name:
	Social Security Number:
	Home Phone:	Mobile Phone:
	Email Address:
	Permanent Home Address:
	Address 2:
	City:	State:	Zip/County:
	Date of Birth:
	Day12345678910111213141516171819202122232425262728293031 MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
	Passport Number:	Passport Country of Origin:
	Blood Type:	Shirt Size: Choose one... XS S M L XL XXL XXXL
	Do you have Faceook? Yes No

Emergency Contact Information:
	Name:
	Relationship to You:
	Home Phone:	Mobile Phone:
	Email Address:
	Address:
	City:	State:	Zip/County:

Beneficiary Information:
	Copy from Emergency Contact Fields
	Name:
	Relationship to You:
	Home Phone:	Mobile Phone:
	Email Address:
	Address:
	City:	State:	Zip/County:

Health Insurance Information:
	Company:
	Policy Number:
	Policy Holder:

Project Information:
	Choose the project you are interested in: I'm not sure yet... International Leadership University Internship - May 30, 2010 Kenya Orphanage Week One - June 03, 2010 Kenya Orphanage WNC Group - June 11, 2010 Fall HIV/AIDS Humanitarian Outreach - October 29, 2010
	Departure City - you will also return to this city:
	Have you ever served on an international humanitarian trip before? Yes No
	If so, where and what were your responsibilities?
	Are you willing to abstain from the use of illegal drugs while on this trip? Yes No
	We are proud to comply with the Americans With Disabilities Act. Please provide any accomodation requirements that we may provide to make your trip more comfortable. (food, allergies, health conditions, etc.)

The information in this document will be kept confidential, and will be disclosed to project personnel only in the events where information is necessary to carry out supervisory responsibilities related to your service with Project Humanity, or in the event law or court order requires any information in this application.

By clicking the submit button below, you acknowledge the following:

The information in this application is true and correct to be the best of my knowledge. I authorize any individuals or organizations listed in this application to give you any information they may have regarding my character and fitness for working with children and I release all such references and Project Humanity from liability for any damage that may result from furnishing such evaluations to Project Humanity.

As I raise support for the project, I realize that those who give on my behalf are contributing to Project Humanity, a not-for-profit organization. In the event that I should not be able to participate for any reason, not limited to sickness, death or any other circumstance, I understand that all gifts are non-refundable, and in the event of my nonparticipation, the gifts given on my behalf will be used by the project and to cover expenses incurred on my behalf. I understand that if I cancel my participation less than 65 full days prior to departure, I agree to be responsible for raising 100% of the project funds despite my non-participation to Project Humanity. This also applies if the trip is cancelled or postponed, should you cancel inside of 65 days from date-of-departure.

One-half of the trip cost (in addition to the deposit) is due 70 days prior to departure with the full balance due 30 days prior to the team departure date. By clicking the submit button below, I understand the above paragraph thoroughly.

Your service through Project Humanity is an elective service opportunity that you are volunteering for. By clicking the submit button below, you agree to hold harmless Project Humanity, our partners, affiliates, Board Members, Advisory Council Members, leaders, other participants and Mission Travel Specialists (our travel provider) for any injury or loss you might sustain personally while serving at a project location or in route to and from the project location. In short, you agree to completely hold harmless any person or entity associated in any manner with Project Humanity. Further, you indemnify Project Humanity and Mission Travel Specialists for any loss (including life) that might result while serving. Country-of-service may change at any time. Depending on recommendations of field personnel, the U.S. Department of State or their recommendations, I understand that the location of our service may change prior to departure.

I realize that included airfare is from the international gateway city (either Los Angeles, New York or Washington, DC) and it is my responsibility to either raise the funds to cover the domestic portion of the trip (in addition to the price of the project), or purchase my own ticket (you may use frequent flier miles).

	Check One: I will book my own domestic airfare I am requesting Project Humanity to book my domestic flight realizing that I am responsible for raising the additional money to cover this cost.

Insurance:
As a part of your service through Project Humanity, we will purchase a supplemental insurance policy in your name (health, emergency evacuation and life). Should you require the use of this policy, there is a $100 deductible and you will be responsible for this expense and expenses that exceed the maximum benefit of this policy. If you would like to review the policy, please contact us!

Authorization:
The information contained in this application is correct to the best of my knowledge. I hereby authorize Project Humanity and its designated agents and representatives to conduct a thorough and comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to Project Humanity, or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release Project Humanity, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.

By submitting my application, I agree to allow Project Humanity, its affiliates, or other associates to use my likeness, image and story for promotional purposes, which may include any type of publication or promotional purposes - both electronic and written for which I will receive no compensation or consideration of any kind. This authorization does not have limitations.

I have read the qualifications and filled out the above application to the best of my ability. I am willing to abide by all the specifications listed and fully understand that any violation to these standards will be grounds for asking me leave the project at my own expense. Should I need to return from the field earlier than the scheduled return date, this will be at my expense.


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By Typing and Submitting the text above, I agree to all items in this application: