My Application | ThisWorldMusic

INSTRUCTIONS: Please use this common application for all ThisWorldMusic programs.

1. 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 from your Permanent Address?*

Yes
No

Mailing Address*

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

Are you currently a student?*

Yes
No

At which institution?*

Are you currently a professional?*

Yes
No

Please upload your resume

Please upload a copy of your passport

You must have a passport valid 6 months beyond the end date of the program.
(NOTE: If you do not currently have a passport, you may upload your driver's license instead.)

2. Program & Travel Preferences

Program destination*

Housing preference – Cuba Summer Program*

Indicate shared or single room for all 10 nights. (Note: For a single room, an additional charge of $600 applies.)

Housing preference – Ghana Summer Program*

For the 3 nights at the Afia Beach Hotel in Accra, indicate whether you would like a single or double occupancy room. (Note: A single room costs an additional $350 total.)

How would you describe your diet?*

Please indicate additional dietary restrictions:

How did you first hear about this program?

Internet search — specific search query:

Flier/poster location:

Brochure location:

Word of mouth — please describe:

Other — please describe:

3. Health Information

Please describe the general state of your health*

Please describe any general health concerns you have at this time:

Have you ever had any of the following?*

Please describe all in as much detail as possible:*

Do you have any allergies?*

Yes
No

What are you allergic to, and how severely?*

Do you require regular medication?*

Yes
No

If yes, please list the names, dosage, and purpose*

Have you within the past 3 years been treated for any mental health issues?*

Yes
No

Please describe in as much detail as possible:*

Emergency Contact*

First Last

Relationship*

Phone Number*

Email Address*

Primary Care Physician Name*

Primary Care Physician Address*

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

Primary Care Physician phone number*

Name of your primary insurance company*

Insurance policyholder's name*

Insurance policy number*

4. Short Responses (1-2 Paragraphs Each)

Explain your reasons — academic, personal and/or professional — for applying to the Cuba program. Please list prior coursework related to this program topic, including department, course number, term taken and grade earned. Also list any foreign language study or experience:*

Explain your reasons — academic, personal and/or professional — for applying to the Ghana program. Please list prior coursework related to this program topic, including department, course number, term taken and grade earned. Also list any foreign language study or experience:*

Detail all past international travel experience:*

Describe Spanish language experience — e.g., formal study, current skill level, travel to a Spanish-speaking countries, etc. (Note: Ability to speak Spanish is NOT required):*

What do you anticipate will be the greatest joys and the greatest challenges of the Cuba program?*

What do you anticipate will be the greatest joys and the greatest challenges of the Ghana program?*