Applications Name *FirstMiddleLastAddressApt / Unit #CityStateZip CodePhoneEmail *Date Of BirthPlace Of BirthAre you a citizen of the United States? *YesNoIf not U.S. citizen, attach copy of permanent resident card. *If not, Country of OriginNearest Relative EducationInstitutionLocationFromToDegr/DateMajor/Minr Employment HistoryEmployerLocationFromToPositionGrade/SubjAttach ResumeAttach any additional documentsWhere did you hear Exploring African Diversity through the Interaction of Environment, People and Culture :A Short-Term Curriculum Development Seminar in Tanzania? Circle one *NewspaperFriendAIRHD Quarterly NewsletterRadioUniversity BulletinAIRHD WebsiteOtherDescribe tour overseas travel experiences and/or activities if any and how this trip will enhance your previous experience: *What is your objective in going to Africa, and how do you anticipate benefiting from this experience? Also describe how you plan to implement what you have learn in Africa upon return to U.S.A *What special skills do you possess (computer, photography, sports, music, communication, foreign language, etc.) *List any special medical needs and/or conditions that AIRHD should be aware ofWhat is the closest Airport to your permanent residence? Disclaimer and Signature: I certify that my answers are true and complete to the best of my knowledge. *Disclaimer and Signature: I certify that my answers are true and complete to the best of my knowledge. Signature *Date *Are you human? * = PhoneWebsiteSubmit