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If you
would like to travel with WFP on one of our delegations, please use the
application below to tell us about yourself. At the conclusion,
you will be asked to include credit card information in order to
charge a deposit, as indicated on the delegation brochure,
required for the processing of your application. A mailing address
will also be provided for payment by check. If you need to
cancel, please review our cancellation
policy first.
If
you have any questions about the Travel Programs
please visit the Travel Program FAQ,
Delegation
Schedule, and/or visit our Contact page
to find staff.
|
 BASIC INFORMATION: (Please fill-in all fields) |
| Name |
(First, Middle,
Last) |
| Address |
|
| City |
State Zip |
| Country |
|
| Phone |
daytime evening |
| E-mail |
E-mail (re-enter)
|
| |
|
| Delegation |
(delegation date or name) |
| |
|
| ADDITIONAL BACKGROUND INFORMATION: (Please fill-in
all fields) |
| D.O.B. |
(mm/dd/yy) Male Female |
Present
Occupation |
|
| Passport # |
Valid Until: (mm/dd/yy) |
| |
|
HEALTH AND
EMERGENCY INFORMATION:
Negative answers to the following
questions will not necessarily prevent you from being invited to travel
with WFP. This information will help us in assessing your special needs
and allow us to take measures which would reduce the risks of serious
health matters during the course of the trip. Providing false
information will result in dismissal from the program and Witness for
Peace is not responsible for health issues that may occur during the
course of the trip. |
General
Health |
|
| List any dietary concerns |
(e.g., vegetarian -- Please note that
while there will usually be vegetarian options, vegan options are very
difficult. Flexibility is necessary as it may be difficult to
accommodate rigid dietary needs in areas where foods are difficult to
get and local customs differ.) |
| Do you have any physical
weaknesses, allergies, disabilities, illnesses that would impact your
mobility on this delegation? No Yes
-- please explain below: |
| |
|
| Do you have any history of drug
and/or alcohol abuse? No Yes -- please explain below: |
| |
|
Have you been hospitalized for an
emotional or mental illness in the last two years? If so, are you
currently under a physician's care or receiving prescribed medication
for this condition?
No Yes -- please explain
below: |
| |
|
Are you currently under a
physician's care or receiving prescribed medication of any kind?
No Yes -- please explain
below: |
| |
|
| Whom should we contact in case of
emergency? (Please make sure that the person knows to call the WFP
office in Washington, DC if it is urgent that they get in touch with
you.) |
| Name |
|
| Address |
|
| City |
State Zip |
| Phone |
home work |
| EDUCATIONAL
AND PROFESSIONAL BACKGROUND: |
| Spanish |
|
Other
Language |
|
Have you ever traveled to Latin
America or the Caribbean?
No Yes -- please briefly
describe your travel experience below: |
| |
|
| Please
provide two personal references. |
|
Name
#1
|
Known Years |
| Phone |
City State |
| Name #2 |
Known Years |
| Phone |
City State |
| Briefly describe your
experience with human rights, social justice, environmental, or other
organizations that are committed to social change. (<150 words) |
|
|
|
| How did you hear about Witness for
Peace and why would you like to participate in the WFP Travel Program?
(<150 words) |
|
|
|
| VALUES AND BELIEFS: |
| Are you a member of a
Denomination |
|
Name
of
Worship Place
|
|
| What is your position on
non-violence? |
| |
|
|
|
