EOI Medical Mission

Applicant Information- EXPRESSION OF INTEREST

Please use this form to show an expression of interest in medical missions to Ukraine with our charity OPT in partnership with Christian Medical Association of Ukraine (www.cmaukraine.com) This is an EOI only and does not commit you to anything.

Name

First

Last

Date Of Birth

Organisation (if applicable)

Email Address

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Position/Title/job

Phone

Expression of Interest

What are you interested in? e.g. medical education, mobile clinics, surgery, teaching - name all that apply

Brief statement expressing the interest and capability.

I would prefer (select all that apply)

Utilising my skills remotely from home
Going anywhere in Ukraine where my skills are needed
Going to Ukraine in less dangerous areas where my skills are needed

that Layout (select

Relevant Qualifications

Outline of qualifications and skills you think will be helpful

Relevant Experience

Outline of past experiences or projects that make you a suitable candidate.

Why do you want to come to Ukraine?

Please describe your state of physical health and fitness?

Additional Information you'd like to share

Space to provide any additional relevant information.

Do you have team members that you would like to bring with you? (please list them)

Space to provide any additional relevant information.

Do you have any specific questions you would like to ask?

We will also send you some general information when we receive this form.

Supporting Documents

These can be provided later if you prefer.

Resume

Click or drag a file to this area to upload.

Recommendation Letters

Click or drag a file to this area to upload.

Please provide at least one recommendation letter that alludes to your suitability for a trip like this, your willingness to work in a team, share skills and /or teach.

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You will have the option to unsubscribe at any time you wish and can select which updates you receive.

I would like to make a tax deductible donation

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EOI Medical Mission

Applicant Information- EXPRESSION OF INTEREST

Expression of Interest

Supporting Documents

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