Program Application

Program Application

  • Name * Required
  • Your email will be the way we contact you the most. It may be best to use your personal email, since you probably check that the most.
  • Please confirm your email
  • For your OGH Swag!
  • Do you have strong plans to participate in a global health elective with another UAMS student or small group of students? * Required
  • If you plan to travel with another UAMS student, please list there name below.
  • Do you have a valid passport that is valid for at least six months after you begin traveling? * Required
  • What is your gender?
  • Our program sites will try to accommodate allergies and dietary restrictions, if notified beforehand. You will probably be eating local foods, so it's best to let us know before you are on the ground. We will try our best to accommodate dietary restrictions but not all food preferences.
  • Do you have a valid passport that is valid for at least six months after you begin traveling? * Required
  • Please provide the following emergency contact information: * Required
  • Are you currently in good academic standing? * Required
  • I agree to register for the online pre-departure orientation. * Required
  • I agree to pay my program cost at least 21 days before departure * Required
  • Human123
  • This field is for validation purposes and should be left unchanged.