Applicant Information

Name*

First Last

Date of Birth*

Email*

Alternate Email

Phone Number*

Permanent Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is your mailing address different than your Permanent Address?*

Yes
No

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please indicate which session:*

Please indicate your housing preference:*

For the nights at the Afia Beach Hotel in Accra, indicate whether you want a single or double occupancy room. (Note: The single room costs an additional $200.)

Please indicate your housing preference:*

For the nights at the Afia Beach Hotel in Accra, indicate whether you want a single or double occupancy room. (Note: The single room costs an additional $350.)

How would you describe your diet?*

Other dietary restrictions — please clarify:

Please provide a copy of your passport

You must have a passport valid 6 months beyond the end date of the program. Click on the file upload above to attach a copy of the photo page of your passport. U.S. citizens who need to get or renew a passport, go to: http://travel.state.gov/passport/get/first/first_830.html. You may attach proof of renewal or application (such as a receipt) of your passport above.

Name

This field is for validation purposes and should be left unchanged.

Ghana Application: Part 2