St. Croix, U.S. Virgin Islands Experience Application

St. Croix, U.S. Virgin Islands Experience Application

Please fill in the name and contact information of the participant
Your Name*

PrefixFirst NameLast Name
Email
example@example.com
Contact Number*
Please enter a valid phone number.
Program Selection

March 13 - March 20, 2026
Participant Type: Are you currently a student or working professional

StudentWorking Health ProfessionalJunior Faculty at an HBCU/Allied InstitutionOther
What is your current academic classification?

FreshmanSophomoreJuniorSeniorGraduate StudentOther
What is your current GPA?
(Use a 4.0 scale) Indicate N/A if it does not apply
Do you have any dietary restrictions?

NoneVegetarianGluten-FreeOther
How did you hear about this program?

Social MediaFriend/ ColleagueWebsiteOther
Emergency Contact Name
Emergency Contact Number
Please enter a valid phone number.
Trip Interest Form

Thank you for your interest in our upcoming trip!

Trip Details:

Capacity: 2-16 participants
Cost: $2,825.00

Payment Schedule:

Deposit: $126.00 (due by October 31, 2025)

Make payments here: https://www.icandocaribbeansocialwork.com/donate

We will meet as a community bi-weekly from 7:00 PM to 8:00 PM to address questions, provide updates, and prepare for our departure.

Kindly submit your information to confirm your interest and commitment. We look forward to traveling with you!
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