EF Gap Year participants are required to complete and return this health form before they are cleared to travel on their program. Note that if you have been treated for any significant physical and/or psychological condition(s) within the past 12 months, your healthcare provider(s) must also complete the appropriate section(s) below. Prior to departure, you must leave a sealed copy of this form with both of your designated emergency contacts. Throughout your program abroad, you must carry a copy of this form with you at all times. You must also notify us immediately (in writing) if there are any changes to the information provided in this form.

Caraway Medical Services provides assistance to EF Gap Year participants during the program. In order for Caraway Medical Services and EF Gap Year to best work together to assist you, we will be sharing the information below with Caraway. Based on the information you provide, Caraway may request you have a pre-travel visit with their clinical team to ensure you have the support you need during your travels. If Caraway’s clinical team believes the program is not compatible with your health needs or medical background, they will inform EF Gap Year of their decision and you will receive a refund of all money paid towards the program. To learn more about Caraway Medical Services please visit caraway.health/education-first.



Participant's full legal name*

Participant's email*

Physical and mental health history*
Self-assessment to be completed by the participant. Select below if you have ever been diagnosed with or have experienced any of the following conditions. Hold down the control button or command button to select all that apply. Select "none" if none apply:


Comment on any conditions checked above, or list any other conditions. Provide as much detail as possible, including severity and if the condition is current or resolved.


Allergies*
Self-assessment to be completed by the participant. Select below if you have ever been diagnosed with or have experienced any of the following allergies. Hold down the control button or command button to select all that apply. Select "none" if none apply:


Comment on any allergies checked above, or list any other allergies. Provide as much detail as possible for each allergy: trigger foods, flora, fauna; severity of reaction; medications for managing symptoms and reactions; and emergency use of epinephrine.

Medical treatment*
Have you been treated by a doctor for any significant physical or mental health issues in the past 12 months? This may include, but is not limited to, physical disabilities, known medical conditions, known allergies or dietary restrictions, current medications and treatments, mental or psychological disabilities, learning disabilities, and known behavioral conditions:


Have you had any hospitalizations or surgeries? If yes, please provide as much details below as possible, including the type and month/year of surgery or hospitalization.

Please list any prescription medications you are currently taking and provide the dosage and reason for use.


Fitness and wellbeing
Self-assessment to be completed by the participant. Our programs can present physical and mental challenges due to their fast-paced nature, which may be outside travelers' familiar comfort zones. Successful program participants must be able to meet all of the following essential eligibility criteria. Please confirm this by checking each box. If you are unable to meet any of these criteria, please contact us to discuss further.

Maintain a positive attitude and exhibit a willingness to try new things.

Travel independently abroad, including internationally from the U.S., between program modules, and on public transportation in host cities.

Be able to manage your own luggage and lift up to 40 lbs.

Be able to follow directions, complex instructions, and accept positive feedback.

Manage daily personal care, and cope with various environmental challenges (heat, cold, altitude, insects, changes in diet).

Walk unassisted for several miles.

Effectively and proactively communicate with staff if you are in pain or under stress and need assistance.

Be able to exercise independent judgment in the absence of direct supervision.

Be able to self-administer ongoing medical treatment while away from home support systems and with professionals through telephone or video chat, if necessary.

Practice self-management techniques in relation to mental health and self-care, including the use of de-stressing habits such as journaling, exercise, meditation, yoga, deep breathing, proper sleep routines, peer support, etc.

Take responsibility for your own self-care and manage any known medical and mental health conditions with a robust support and communication plan between you and your physician(s).

If taking prescription medications, be able to independently manage storage, dosage and administration.

Bring a sufficient amount of medication to last for the duration of the EF Gap program.

Comment on any concerns or additional well-being support you might need from EF Gap Year to successfully complete your program abroad.



By submitting this form, I attest that the information provided in this Health Form is true and correct to the best of my knowledge. I understand that the intentional omission of any significant known physical or mental health conditions within the past 12 months may result in my immediate dismissal from my EF Gap program. With this signature, I also give my permission to EF Gap Year and/or its designated Safety and Incident Response Team to contact the person(s) and/or organization(s) listed in Section 4 to share any or all of my medical and/or behavioral records. This authorization is valid throughout the duration of my EF Gap program.
EF Gap Year participants are required to complete and return this health form before they are cleared to travel on their program. Note that if you have been treated for any significant physical and/or psychological condition(s) within the past 12 months, your healthcare provider(s) must also complete the appropriate section(s) below. Prior to departure, you must leave a sealed copy of this form with both of your designated emergency contacts. Throughout your program abroad, you must carry a copy of this form with you at all times. You must also notify us immediately (in writing) if there are any changes to the information provided in this form.

Caraway Medical Services provides assistance to EF Gap Year participants during the program. In order for Caraway Medical Services and EF Gap Year to best work together to assist you, we will be sharing the information below with Caraway. Based on the information you provide, Caraway may request you have a pre-travel visit with their clinical team to ensure you have the support you need during your travels. If Caraway’s clinical team believes the program is not compatible with your health needs or medical background, they will inform EF Gap Year of their decision and you will receive a refund of all money paid towards the program. To learn more about Caraway Medical Services please visit caraway.health/education-first.



Participant's full legal name*

Participant's email*

Physical and mental health history*
Self-assessment to be completed by the participant. Select below if you have ever been diagnosed with or have experienced any of the following conditions. Select all that apply. Select "none" if none apply:


Comment on any conditions checked above, or list any other conditions. Provide as much detail as possible, including severity and if the condition is current or resolved.


Allergies*
Self-assessment to be completed by the participant. Select below if you have ever been diagnosed with or have experienced any of the following allergies. Select all that apply. Select "none" if none apply:


Comment on any allergies checked above, or list any other allergies. Provide as much detail as possible for each allergy: trigger foods, flora, fauna; severity of reaction; medications for managing symptoms and reactions; and emergency use of epinephrine.

Medical treatment*
Have you been treated by a doctor for any significant physical or mental health issues in the past 12 months? This may include, but is not limited to, physical disabilities, known medical conditions, known allergies or dietary restrictions, current medications and treatments, mental or psychological disabilities, learning disabilities, and known behavioral conditions:


Have you had any hospitalizations or surgeries? If yes, please provide as much details below as possible, including the type and month/year of surgery or hospitalization.


Please list any prescription medications you are currently taking and provide the dosage and reason for use.


Fitness and wellbeing
Self-assessment to be completed by the participant. Our programs can present physical and mental challenges due to their fast-paced nature, which may be outside travelers' familiar comfort zones. Successful program participants must be able to meet all of the following essential eligibility criteria. Please confirm this by checking each box. If you are unable to meet any of these criteria, please contact us to discuss further.

Maintain a positive attitude and exhibit a willingness to try new things.

Travel independently abroad, including internationally from the U.S., between program modules, and on public transportation in host cities.

Be able to manage your own luggage and lift up to 40 lbs.

Be able to follow directions, complex instructions, and accept positive feedback.

Manage daily personal care, and cope with various environmental challenges (heat, cold, altitude, insects, changes in diet).

Walk unassisted for several miles.

Effectively and proactively communicate with staff if you are in pain or under stress and need assistance.

Be able to exercise independent judgment in the absence of direct supervision.

Be able to self-administer ongoing medical treatment while away from home support systems and with professionals through telephone or video chat, if necessary.

Practice self-management techniques in relation to mental health and self-care, including the use of de-stressing habits such as journaling, exercise, meditation, yoga, deep breathing, proper sleep routines, peer support, etc.

Take responsibility for your own self-care and manage any known medical and mental health conditions with a robust support and communication plan between you and your physician(s).

If taking prescription medications, be able to independently manage storage, dosage and administration.

Bring a sufficient amount of medication to last for the duration of the EF Gap program.

Comment on any concerns or additional well-being support you might need from EF Gap Year to successfully complete your program abroad.



By submitting this form, I attest that the information provided in this Health Form is true and correct to the best of my knowledge. I understand that the intentional omission of any significant known physical or mental health conditions within the past 12 months may result in my immediate dismissal from my EF Gap program. With this signature, I also give my permission to EF Gap Year and/or its designated Safety and Incident Response Team to contact the person(s) and/or organization(s) listed in Section 4 to share any or all of my medical and/or behavioral records. This authorization is valid throughout the duration of my EF Gap program.