Travel Forms
Start planning with these important forms. Links below.
To learn about our outreach program and locations, check out the Countries and Schedules of Trips guide.
To make payments for upcoming events, please click here.
If you would like to learn more about the COM International Medical Outreach Programs, please contact em1036@nova.edu
Outreach Program Leader: Dr. Paula Anderson-Worts
Dates: Dec 9-17, 2018 – Montego Bay (St. James), Jamaica
Estimated Cost: $1,350.00 (+/- $50) for the entire trip. Cost includes flight, hotel, ground transportation and ~70% of meals. Price is subject to change since flight arrangements have not been finalized.
APPLICATIONS:
Non-NSU Participants:
Go to the “Jamaica” section to download and print the application that is specific to your level of involvement. Students no matter what discipline should complete the “Student/Volunteer” application.
NON-NSU Jamaica Application Forms All forms for Jamaica (below) must be sent to Dr. Anderson-Worts.
NSU Faculty and Students:
How to submit application click on Instructional Guide.
NSU Application Form
Students click on New Item to begin application.
Completed application is due to your discipline coordinator by: Monday, October 1, 2018
Discipline Coordinators should submit completed applications to Dr. Anderson-Worts or Dr. Luzan Phillpotts.
FULL DEPOSIT MUST ACCOMPANY YOUR APPLICATION
Checks Made Payable to “Women of H.O.P.E.”
All participants must complete a mission trip application. The Jamaica Ministry of Health has several required forms to be completed prior to the mission. Please complete the forms by the requested deadline, so the paperwork can be processed and submitted in a timely fashion.
No refunds after Friday November 2, 2018.
Please Note: Airline Tickets are non-refundable once they are purchased regardless of the full refund deadline.
PASSPORT IS REQUIRED FOR TRAVEL TO JAMAICA!!
If you do not have a passport, please make sure you go to the nearest passport agency and complete the application in a timely manner. IT WILL TAKE 6-8 WEEKS (sometimes longer) to receive a new passport. If you do not have a passport by the travel time allotted, you will not be able to participate in the medical mission.
TRAVEL INSURANCE: All participants must submit proof of Travel Insurance with their applicable.
Proof of travel insurance is mandatory in order for you to participate in the mission. At least $2,000,000 medical benefits are recommended. Please note emergency evacuation and reparation must be included.
If you do not have travel insurance then you can obtain travel coverage from International Student Insurance.
We do not endorse any specific Insurance Company. NSU has negotiated travel insurance that includes the above listed requirements in addition to trip cancellation coverage at a reasonable cost.
NSU recommends for Students, Faculty and outreach participants: Health Travel Insurance
Jamaica Mission Trip Coordinators:
Outreach Program Leader: Dr. Jill Wallace-Ross
Dates (Approx.): December 8-18, 2018
Price: Approx. $1,800.00 - Includes airfare, in-country transportation, lodging, transportation to/from airport, all meals and some excursions.
Deposit: 1 st deposit of $600.00 due 9/10/18, 2 nd deposit of 600.00 due by 10/1/2018 and final payment of $600.00 due by 11/1/2018 – Payment instructions will be sent after online application is submitted. No refunds after airfare is booked.
The India Medical Outreach Program is geared towards the healthcare needs of thousands of underprivileged tribal people of surrounding areas of Gujarat, India. Students, faculty, physicians, dentists, staff and volunteers from the community give their time and talent to provide medical care that would otherwise be unavailable due to the significant shortage of healthcare professionals.
Our goal is to provide quality care and build sustainable relationships with community residents. Participants will have the opportunity to practice, teach, perform research, and treat an extremely wide variety of diseases.
Please click on the following link to complete your application: https://liverootnova.sharepoint.com/osmedoutreach/Pages/default.aspx
Non-NSU Participants please retrieve Application form from the following URL: http://osteopathic.nova.edu/community/international-programs/international-programs.html
Completed application and 1 st deposit of $600.00 due by: September 10, 2018. For additional information please contact: Evelyn Martinez at (954) 262-1897 .
Outreach Program Leader: Dean Elaine Wallace, DO, MS, MS, MS
Dates (Approx.): March 2-10, 2019
Price: Approx. $1,750.00 includes airfare, in-country transportation, lodging, all meals and opportunities for birding and/or hiking.
Deposit/Application: $600.00 due by 1/10/2019 with completed application. Final payment due on 2/4/2019.
The Ecuador Medical Outreach Program provides free medical care to the underserved population in rural areas of Ecuador. Students, faculty, physicians, dentists, staff and volunteers from the community give their time and talent to provide medical care that would otherwise be unavailable due to the significant shortage of healthcare professionals.
The areas served range from beautiful mountains under 9,000 feet to the cloud forests and eventually down to the rain forest. The local leader is a veterinarian and an environmentalist who not only works with us in arranging our sites but also shows us ways to better see the beautiful environment in which we will be providing the health care services.
For Additional Information: Please contact Evelyn Martinez or at (954) 262-1897.