Choose Your Program*

Your Name (First and Last)*

Nickname (Preferred Name)

Address*

Phone Number*

Student Email*

Birth Date (Month/Day/Year)*

Current Age*

Nationality*

Gender*

Work History*

Education History*

Briefly Describe Any Experience in Volunteer or Community Service Work*

Special Interests/Hobbies/Skills/Training (List Degrees/Certificates/Training Earned)*

Native Language

Other Languages Spoken (are you fluent?)

Level of Proficiency in English

How long have you spoken/studied English?

Do you have special health considerations (allergies, illness, disability) we should know of?

This information is imperative in ensuring your safety and will remain confidential.*

Please tell us about your family and home life.*

Please tell us about your work life.*

Briefly describe any travel experience you have.*

What do you hope to derive from the Power of One experience?*

What do you feel you, personally, can offer to this year's Power of One program?*

Are there any special skills that you possess which might be used on the program (beading, painting, singing, acting, photography, etc.)

We encourage you to bring your passions with you on this trip!*

Is there any other information you wish to share, or do you have any questions about the program?

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