Apply | Sankofamusicimmersion | African Drumming & Dance Study Abroad and Workshop

Applicant Information

Name *

First

Last

Date of Birth *

Email *

Alternate Email

Phone *

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is your mailing address different from your Permanent Address? *

Yes
No

Are you currently a student *

Yes
No

File Upload *

You must have a passport valid 6 months beyond the end date of the program. (NOTE: If you do not currently have a passport, you may upload your driver's license instead.)

Program & Travel Preferences

Music Immersion / Travel & Tours *

How would you describe your diet?

Please indicate additional dietary restrictions:

Health information

Please describe the general state of your health *

Please describe any general health concerns you have at this time: *

Do you have any allergies? *

Yes
No

Have you within the past 3 years been treated for any mental health issues? *

Yes
No

Emergency Contact *

First

Last

Relationship *

Phone *

Email *

Primary Care Physician Name *

Primary Care Physician Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Care Physician phone number *

Apply for the Experience

Please complete the form below to email us.
We will respond in 2-3 business days

Immerse Yourself in Ghanaian Culture

Applicant Information

Program & Travel Preferences

Health information

Apply for the Experience

Please complete the form below to email us. We will respond in 2-3 business days

Immerse Yourself in Ghanaian Culture

Applicant Information

Program & Travel Preferences

Health information

Please complete the form below to email us.
We will respond in 2-3 business days