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United Planet Virtual Exchange Application Form - American-Iraqi Public Health Teams Addressing COVID-19 Project

Thank you for your interest in United Planet's Global Health Summer Program. Please complete the information below for all required fields. Your information will be kept confidential and only available to the review team and United Planet Program Administrators. Information collected is to ensure we are including people from a variety of backgrounds into the Program.
1.First Name(Required.)
2.Last Name(Required.)
3.Your Address(Required.)
4.Gender(Required.)
5.If you chose other for the question above, please specify
6.Which Country do you currently live in?(Required.)
7.What best describe your ethnic origin?(Required.)
8.If you chose other for the question above, please specify
9.Religion
10.What will your grade/year be for the upcoming academic calendar year of 2020-2021(Required.)
11.Briefly describe why you are interested in this Cultural Virtual Exchange Program(Required.)
12.What are your learning goals for this Program?(Required.)
13.What is your native language?(Required.)
14.On a scale of 1 to 5, how prepared are you to working with people from different backgrounds, cultures, and countries as team?(Required.)
Not At All Prepared
Less Prepared
Somewhat Prepared
Prepared
Well Prepared
15.On a scale of 1 to 5, how inspired are you to working together with others to help solve challenges outside of your community?(Required.)
Not At All Inspired
Less Inspired
Somewhat Inspired
Inspired
Very Inspired
16.I am a (please choose):(Required.)
Current Progress,
0 of 37 answered