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* 1. First and Last Name:

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* 2. Preferred Email:

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* 3. MIIS Degree Program:

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* 4. Current Semester (1st, 2nd, 3rd, 4th, etc.):

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* 5. Would you like to stay in Kenya for an internship with the Omega Foundation or its grantees/affiliates after the training?

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* 6. If so, how long would you plan to stay and intern (i.e. summer only or summer-fall)?

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* 7. Why do you want to do this program?

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