Todays Date
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MM
DD
YYYY
Name
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First Name
Last Name
Email
*
Phone
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(###)
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Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of Birth
*
MM
DD
YYYY
Do you have any special skill sets that may be useful in this program?
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(i.e. Life Guard Certification, arts & crafts, Administrative, bible teaching, worship, intercession, food prep, construction experience, small group experience etc.)
What are some skill sets you would like to grow-in or try for the first time?
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Worship, teaching, construction, cooking, sharing your faith, leading groups, etc.
Please tell us why you would like to be a part of this program
Are you currently attending a church?
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If so please tell us what church you attend. If not please explain why you are not in church at this time in your life.
Tells us about your relationship with Jesus
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Learning Interests
This mission trip involves training as well as active serving. What are you most interested in learning during the training portion? (Select all that apply)
Service Confirmation
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This is a rigorous program involving self-studying, required class attendance, and participation in serve activities. On average you will spend 40 hours per week actively engaged in the curriculum. Please confirm that you are aware, and capable.
Name of a work/volunteer reference you can provide.
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A Supervisor— not a peer
First Name
Last Name
Phone Work/Volunteer Reference
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(###)
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Email Work/Volunteer Reference
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Pastoral Reference
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This needs to be someone who can speak to your spiritual life. This does not have to be an official pastor.
First Name
Last Name
Phone Pastoral Reference
*
(###)
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Email Pastoral Reference
*
How did you hear about us?
Email marketing
Friends or Family
Google search
Radio
Video Ad
Recruited directly
Campus tabeling event
Returning
other
Do you have any activities you would like to do if you are apart of this program?
This program will involve lots of social activities with peers including a trip to the coast, hikes, river activities and games. Are there any ideas or places to visit you would like us to try and incorporate into the community fun time?.
Do you need resources to assist you in fundraising for this missions experience?
Scholarships
We provide scholarships under certain cases. If you need a scholarship in order to participate in this program please write down a monetary value of the amount you believe you are capable of contributing to your program cost.
You will be contacted will follow up questions if we are able to find a generous donor.
