APPLICATION FORM

Apply so we can help!

Are you a doctor in a village in rural areas of Africa and in need of healthcare supplies and medicine?

Fill in the information below and we will contact you as soon as possible to create a plan to support your village with medical supplies and medicine!

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Thank you for applying! We will contact you as soon as possible.

Name

Adress village

Condition of the village

Number of villagers

Number of medical workers

Condition of dispensary/hospital

Which medical equipment is needed? And why?

Which medicine is needed? And why?

Message to us

You can send attached documents and pictures of the villages dispensary/hospital once we respond to you on email.

*We are currently not taking any applications but will be available again from november 2025 🙂 Don’t hesitate to contact us then!