Experience Ghana Application

Experience Ghana Application
Participant Information

Please fill name and contact information of participant.
Name*

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

May 22 - June 05, 2026
Participant Type: Are you currently a student or working professional

StudentWorking Health ProfessionalJunior Faculty at an HBCU/Allied InstitutionOther
What is your current GPA?
(Use a 4.0 scale) or Indicate N/A if it does not apply
Do you have any dietary restrictions?

NoneVegetarianVeganGluten-FreeOther
How did you hear about this program?

Social MediaFriend/ColleagueWebsiteOther
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.
Trip Interest Form

Thank you for your interest in our upcoming trip to Ghana!

Trip Details:

Cost: $4,626.00

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!
Should be Empty:

Participant Information