CONFIRMATION OF INTENT

NOTE: By signing your name electronically on this form, you agree that your electronic signature is the legal equivalent of your manual signature.

Please note that because we serve vulnerable populations, acceptance into any Compass program may be contingent on a background check which will be conducted prior to the trip with your consent.

Additionally, this information will be used to purchase your plane ticket, so it is critical that you enter your information exactly as it appears on your passport.

First Name (As it appears on your passport)

Middle Name (As it appears on your passport)

Please write "N/A" if you don't have a middle name

Last Name(s) (As it appears on your passport)

Date of Birth

YYYY

Please select one option:

Yes! I will participate in the Compass program. I understand that this requires full participation for the entire duration of the program and I will submit a $250 deposit with the link Compass provides to secure my spot in the program.

No, I will not participate in Compass and hereby forfeit my spot in the program.

Typed Signature

First Name

Last Name

Today's Date

YYYY