Eligibility requirements:
• IDSA member
• Confirmed enrollment in volunteering program with credible NGO
• Enrollment or completion of CDC training course, or other similar training course such as MSF training course
• Confirmed deployment to West Africa after November 1, 2014

Please fill out the entire form for your application to be considered.

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* 1. First Name

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* 2. Last Name

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* 3. Institutional Affiliation

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* 4. Position

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* 5. Home Address

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* 6. Email Address

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* 7. Phone Number

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* 8. Organization volunteering with

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* 9. Planned date of departure

Date

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* 10. Planned location of deployment

Please forward a letter or email from the NGO you are volunteering with to globalhealth@idsociety.org, to verify your deployment, along with letter or email verification from the CDC or other organization regarding Ebola training course registration or completion.

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