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
Accepted file types: jpg, gif, png, pdf.
Please upload a copy of your passport
Accepted file types: jpg, gif, png, pdf.
You must have a passport valid 6 months beyond the end date of the program.
(NOTE: If you do not currently have a passport, please upload your driver's license.)
2. Program & Travel Preferences
Program destination*
Ghana session*
Housing preference – Ghana Winter Session*
For the nights at the Afia Beach Hotel in Accra, indicate whether you want a single or double occupancy room. (Note: A single room costs an additional $250 total.)
Housing preference – Ghana Summer Session I*
For the nights at the Afia Beach Hotel in Accra, indicate whether you want a single or double occupancy room. (Note: A single room costs an additional $250 total.)
Housing preference – Ghana Summer Session II*
For the nights at the Afia Beach Hotel in Accra, indicate whether you want a single or double occupancy room. (Note: A single room costs an additional $375 total.)
Cuba session*
Housing preference – Cuba Winter Session*
Indicate shared or single room for all 10 nights. (Note: For a single room, an additional charge of $450 applies.)
Housing preference – Cuba Summer Session*
Indicate shared or single room for all 10 nights. (Note: For a single room, an additional charge of $450 applies.)
How would you describe your diet?*
Please indicate additional dietary restrictions:
How did you first hear about this program?
- Internet search
- Facebook
- Instagram
- Percussive Arts Society e-newsletter
- Percussive Notes magazine
- Brochure
- Flier/poster
- ThisWorldMusic workshop/event
- UMass Amherst website
- Abroad101.com
- StudyAbroad.com
- GoAbroad.com
- Word of mouth
- Other
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?*
- Asthma
- COPD
- Other respiratory issues
- Heart problems (arrhythmia, congestive heart failure, angina etc.)
- Blood pressure issues
- Anemia
- Bleeding issues
- Chronic or recurrent gastrointestinal issues (Crohns, ulcerative colitis, IBS, etc.)
- Bladder/kidney issues
- Diabetes
- Seizures/epilepsy
- History of fainting
- Headaches
- Anxiety
- Depression
- Other mental illnesses (bipolar, schizophrenia, OCD, etc.)
- Significant allergic reactions (if so, please describe)
- Other
- None of the above
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)
1. Explain your reasons — academic, personal and/or professional — for applying to this 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:*
2. Detail all past international travel experience:*
3. 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):*
3. What do you anticipate will be the greatest joys and the greatest challenges of the Ghana program?*
4. What do you anticipate will be the greatest joys and the greatest challenges of the Cuba program?*
4. What do you anticipate will be the greatest joys and the greatest challenges of the Ghana program?*
5. What do you anticipate will be the greatest joys and the greatest challenges of the Cuba program?*

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Questions? info@thisworldmusic.com

1. Applicant Information

2. Program & Travel Preferences

3. Health Information

4. Short Responses (1-2 Paragraphs Each)