Project Vietnam Foundation PO Box 9479, Fountain Valley, CA 92728 Phone: 714-888-5800 Email: [email protected] Website: www.projectvietnam.org

APPLICATION CHECKLIST

After submitting the online application, print out this checklist and complete all of the following items. Please mail in the completed checklist and the required items to Project Vietnam Foundation. Name E-mail

Phone Number

REQUIRED ITEMS - Complete and mail in the following (7) items to the PVNF office, even if you have already submitted them online. To ensure proper receipt of your documents, please check off every item that you send in with this checklist. IMPORTANT: PLEASE ADDRESS PROFESSIONAL LICENSES IMMEDIATELY IN ORDER TO BEGIN VISA APPLICATION PROCESS

Visa Application – please check below the applicable line -- If you already have a visa, send in a color copy of the visa -- If you do not have a visa, you need to fill out an online Visa Application, print a copy, sign it and send it to us. (see instructions for filling out visa application online)* Color copy of your passport -- Send in a printed color copy even if you have uploaded one online -- Black and white copies are not accepted by the Vietnam consulate 2 Passport Photos (1 for your badge + 1 for visa application) -- Photos should be 2”x2” on photo paper. It must have your full face with a plain background. -- Write your name (the participant) on the back of each photo Initial deposit check ($250 for health professionals & $100 for non-health volunteers) -- Make the check out to Project Vietnam Foundation, this will be used for the visa processing and is non-refundable -- Write your name (the participant) on the memo line of the check. -- If you are paying for other participants, please write separate checks for each person Professional License (for health professionals; MD, Dentist, Pharmacist) or College Diploma / Proof of School Enrollment (for students) – the certification for Health Professionals may take 3 weeks! For Health Professionals only: please bring your original license and a copy to a notary public to certify the copy as conformed to original. You will need to send the notarized copy to your State Secretary of State for a Certification of the Notary public (cost $1-$20, takes usually 8-10 days). Send all the docs. Resume or Curriculum Vitae – Please include any certificates (CPR and others) Release of Liability (signed)

Please send all documents/checks to Project Vietnam Foundation PO Box 9479, Fountain Valley, CA 92728 Comments/Notes:

For office use:

Received Date

Processed By / Date

Complete Date

Project Vietnam Foundation PO Box 9479, Fountain Valley, CA 92728 Phone: 714-888-5800 Email: [email protected] Website: projectvietnam.org

RELEASE OF LIABILITY & DECLARATION OF INTENT The undersigned _________________________________________________________ has voluntarily signed up for a trip to Vietnam for the time period _______/_______/20_________ to _______/________/20________

I agree to release and indemnify Project Vietnam Foundation and all leaders and other organizations involved in this

trip from all liability. I also grant PVNF permission to use photos, videos, and/or audio of myself or which I took during the trip.

I understand that I am acting as a goodwill ambassador, and will not engage into any behavior which may reflect poorly on Project Vietnam and my country during my stay in Vietnam. I also warrant that my purpose is

humanitarian and educational, and will not engage into any political or unlawful activity under the laws of the host country.

I have committed to perform a research/study/project and will make the project activities my priority during the project duration. I will communicate weekly to give a progress report to Dr. Kieu and/or her designee, and will provide promptly periodic reports and data collection as I obtain them. Upon completion of the project, I will provide to Project Vietnam Foundation a final report within 30 days.

I agree that the study is the property of Project Vietnam to be used towards healthcare assistance for Vietnam, and I will observe confidentiality on data obtained. I will obtain Project Vietnam authorization for any public use of the data, said permission will not be unreasonably withheld.

I have voluntarily signed this declaration, and represent I am of legal age in the US Date: _______/________/ 20______ Name:

___________________________________________________________________________________________________________________________

Signature:

________________________________________________________________________________________________________________________

Check

whenever applicable

Project Vietnam Foundation

PO Box 9479, Fountain Valley, CA 92728 Phone: 714-888-5800 Email: [email protected] Website: projectvietnam.org

VIETNAM VISA APPLICATION INSTRUCTION Please follow through with the instructions below and mail in the visa application. A sample of the new visa application is included for your reference. 1.

Go to the Vietnam Visa Application web page (Vietnam Ministry of Foreign Affairs) at http://visa.mofa.gov.vn

3.

Click on “ Fill form” to begin and answer all mandatory questions marked (*)

2. 4.

5. 6. 7.

Select English at top right of web page.

Answer the information boxes on Page 1 as followed: a. Purpose of Entry: Select "Other purpose" from list b. Specify purpose of entry: Project Vietnam group c. Place of visa submission: Select "Consulate General of Viet Nam in San Francisco (USA)" from list d. Place of visa collection: Select "Consulate General of Viet Nam in San Francisco (USA)" from list e. DO NOT upload photo Click next to go to Page 2

Please refer to the Sample "New Visa Sample App" to help you answer questions on Page 2. Note date format used in Vietnam is dd/mm/yyyy.

Besides filling out your personal information, answer the following information boxes on Page 2 as follows: a. Current Address: 15975 Harbor Blvd, Fountain Valley, CA 92708 b. Email: [email protected] c. Proposed entry date: Enter date you will be arriving in Viet Nam d. Passport type: Select "Ordinary" from list e. Visa validity: Select "30 day" from list (If you are staying longer then 30 days, specify your own exit date in the "Proposed exit date" info box.)

f.

8. 9.

g.

Number of entries: Select "Single" from list

(Select "Multiple" if you will travel to other countries then return to Vietnam again.)

Proposed address in Viet Nam: In Saigon with Project Vietnam group

Click next to go to Page 3

Answer the information boxes on Page 3 as follows: a. Click on "Organization" b. Name: Project Vietnam Foundation c. Address: 15975 Harbor Blvd, Fountain Valley, CA 92708 d. Telephone number: (714) 888-5800

10. Don't forget to enter pattern at bottom of page before clicking "Next" to complete your process 11. Print, sign and send new visa application to our office at: Project Vietnam Foundation PO Box 9479 Fountain Valley, CA 92708

15975Har borBl vd Fount ai nVal l ey , CA92708 7148885800

7148885800

Project Vietnam Foundation

PO Box 9479, Fountain Valley, CA 92728 Phone: 714-888-5800 Email: [email protected] Website: projectvietnam.org

Certification of Notary Public Instruction (California Sample) Please refer to your Secretary of State OF YOUR STATE Authentications: Certification • The California Secretary of State authenticates signatures only on documents issued in the State of California signed by a notary public or the following public officials and their deputies:

— County Clerks or Recorders — Court Administrators of the Superior Court — Executive Clerks of the Superior Court — Officers whose authority is not limited to any particular county — Executive Officers of the Superior Court — Judges of the Superior Court — State Officials • Authentication requests can be submitted by mail to our Sacramento office. The processing time is typically six to eight business days from the date the request is received in the Sacramento office.

• When submitting a request for authentication by mail, please include the following items:

— The original notarized and/or certified document(s). A photocopy is not acceptable. — A cover letter stating the country in which the document will be used. — A check or money order for the authentication fee of $20 per authentication certificate made payable to Secretary of State and payable in U.S. dollars. — A self-addressed envelope for the return mail. If you wish to use a mail tracking service, please provide a pre-paid air bill. If you do not use a prepaid service, our office will mail your document(s) by U.S. Postal Service regular mail at no charge.

• Authentication requests can be presented in person to our Sacramento or Los Angeles office locations for processing between the hours of 8:00 a.m. and 4:30 p.m., Monday through Friday (excluding holidays). A $20 fee for each authentication certificate and an additional $6 special handling fee for each different public official's signature to be authenticated is required. When presenting a request in person to either of our offices, no appointment is necessary. Customers are served on a "first come first serve" basis. Payments can be made by check, money order, or credit card (Visa or MasterCard). Cash is only accepted

PLEASE REFER TO THE SECRETARY OF STATE WEBSITE: http://www.sos.ca.gov/notary

Project Vietnam Foundation

PO Box 9479, Fountain Valley, CA 92728 Phone: 714-888-5800 Email: [email protected] Website: projectvietnam.org

FOR RETURNING APPLICANTS This form is for returning applicants who have been on missions in the last 2 years. Please note that if there are no changes, information from the previous mission will be used for this trip.

NAME OF RETURNING APPLICANT: ___________________________________________________________ EMAIL: ________________________________________________________________________________

HOME NUMBER: ______________________________

MOBILE NUMBER: _________________________

PLEASE LIST PREVIOUS YEAR(S) PARTICIPATED: ___________________________________________________________ HAS YOUR PASSPORT EXPIRED RECENTLY OR WILL IT EXPIRE WITHIN 6 MONTHS AFTER THE LAST DAY OF UPCOMING MISSION TRIP? PLEASE CHECK ANSWER: YES ______NO ______ (IF YES, PLEASE RENEW PASSPORT AS SOON AS POSSIBLE) HAS YOUR ADDRESS CHANGED SINCE YOUR LAST MISSION TRIP? YES ______NO ______ (IF YES, PLEASE PROVIDE CURRENT ADDRESS) ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ADDITIONAL COMMENTS / PREFERENCES: _______________________________________________________________ __________________________________________________________________________________________________ SPECIAL DIET: ______________________________________

ROOM PREFERENCE: _____________________________

PLEASE SPECIFY IF WILLING TO HELP ON SPECIFIC AREAS: ____________________________________________________________

______________________________________________________________________________________________________________________

As the checklist has changed from last year, please note the following changes: • •

Online Visa application (instructions enclosed). Working permit for Healthcare Professionals (instructions in checklist).

Please send all documents/checks to Project Vietnam Foundation PO Box 9479, Fountain Valley, CA 92728 [email protected]

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