APPLICATION FORM FOR EXPLORE TRIP

For Students and Young Professionals — Complete the form and receive an automatic response email.

Applying as *

Choice of Destination *

Name as appears on passport

First Name *

Middle Name

Last Name *

Do you have any previous names? *

If yes, what is it?

Gender *

Date of birth (passport) *

Place of birth *

Nationality *

Other citizenship (if any)

Country of residence *

Permanent address *

Email address *

Alternative email address

Telephone #1 *

Telephone #2

WhatsApp number *

Parents / Guardian

Mother's name *

Mother status *

Mother telephone (if alive)

Mother occupation (if alive)

Father's name *

Father status *

Father telephone (if alive)

Father occupation (if alive)

Marital / Health

Marital Status *

Maiden name of spouse (if married)

Telephone # of spouse (if married)

Number of children born

Any physical disability? *

If yes, state

Dietary preferences? *

If yes, state

Any allergy? *

If yes, state

Emergency Contact

Name of emergency contact person *

Relationship with applicant *

Phone #1 *

Phone #2

Hobbies

Education

Name of current/last Educational Institution *

Student ID number

Year of admission *

Year of completion *

Degree Type *

Course *

High School

Name of High School attended *

Year of admission *

Year of completion *

Qualification *

Employment

Currently employed or volunteering? *

Sector (if yes)

Name of Organization

Title

Year of recruitment

Address

Roles include

Any previous employment/volunteering? *

Previous sector (if yes)

Previous Organization

Previous Title

Previous Year of recruitment

Previous Address

Previous Roles include

Interests / Visa / Passport

Area(s) of Interest *

You can type: Technology and Innovations, Education and Capacity Building, Health and Sanitation, etc.

Do you require a visa to enter Destination Country? *

If No, explain

Passport number *

Place of issue *

Date of issue *

Date of expiry *

Any recent international travel since Jan 2024? *

If Yes, list (date of travel, return, purpose)

Refused visa/entry since Jan 2024? *

If yes, state details (date, country/embassy, purpose, reason)

Why do you want to join Explore? *

How did you hear about Explore? *

If Other, specify

Any other information you wish to add

I declare the information is accurate and I accept the Explore Terms & Conditions *

After submission, you will receive an email response with your Participation Code.