NWB-Haiti Global Citizen Program Application

Please fill out all required fields. A scan or copy of your passport (and healthcare practitioner license/registration, if applicable) must be submitted to NWB via the Document Upload below.

Email questions to Sharon Barefoot, Volunteer Coordinator: volunteer@nwb.ngo

 

    Your Name (required)

    Your Email (required)

    Select Document Type: MAX 10MB
    Passport/VisaSigned FormsHealthcare Practitioner License/RegistrationResearch DocumentOther

    Additional Pages: MAX 10MB
    Passport/VisaSigned FormsHealthcare Practitioner License/RegistrationResearch DocumentOther

    Additional Pages: MAX 10MB
    Passport/VisaSigned FormsHealthcare Practitioner License/RegistrationResearch DocumentOther

    Additional Pages: MAX 10MB
    Passport/VisaSigned FormsHealthcare Practitioner License/RegistrationResearch DocumentOther

    Additional Pages: MAX 10MB
    Passport/VisaSigned FormsHealthcare Practitioner License/RegistrationResearch DocumentOther

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