BEL Application

***PLEASE COMPLETE THIS APPLICATION WITH A COMPUTER.*** We have been notified that users applying with a mobile device are having issues. We are working to fix this problem. Thank you for your patience.

Postal Locality/District/Department
Description of occupation

Emergency Contact (Haiti)


If applicable
Postal Locality/District/Department

Emergency Contact (United States)


If applicable
Type "NA" if you have no passport
Type "NA" if you have no visa
At least 500 Words (Recommended)
At least 200 words (Recommended)

I understand that if I am selected to participate in this program, I will return to my home country
as scheduled by BEL Haiti Initiative (Does not apply to applicants with U.S. Visa). By providing my signature, should I not return as scheduled, BEL Haiti Initiative has the right to provide my identity and information to the officials of the United States Citizenship and Immigration Services.

If you have misrepresented or omitted any facts relative to this application, you can be denied or discharged from this program.

Do NOT follow this link or you will be banned from the site!