APPLICATION TO JOIN A TEAM TO HAITI

* Required


























High School Diploma
Some College
College Diploma
Some Graduate Work
Graduate Degree
Ph.D.
Certificate - list
Licences - list



Epilepsy
Ephysema
Allergies(inc. allergies to medications)
High Blood Pressure
Eating Disorder
Back problem or other injuries
Diabetes
Substance abuse or other chemical dependencies
Asthma
Other medical condition - please list
none of the above






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