Mission Application




Date of trip applying for: *
Host:
(Church, Organiztion, etc)
*
Name (as printed on your Passport): *
Address: *
City: *
State: *
Zip Code: *
Phone: *
Alternate Phone:
Email Address: *
Date of Birth: *
Male/Female: *

Social Security # (for possible background check): *
A passport is required.
Passport#
*
Expiration Date *
Are you a US citizen? *

Emergency Contact Name
Emergency Contact Phone Number:
Relationship to you:

Spiritual Information


Do you attend church regularly?

Are you a member?

If so where?
Pastors name:
Are you actively involved in any ministries in your church?

If yes, which ministries?

Personal Information


Do you speak a foreign language?

If so, what language?
Please list any specific talents or abilities that you have:
Any relationships between you and others applying for this trip?
Is there anything that you feel we should know about your personal life that could affect you or the team?
Do you have any chemical dependencies?

If so, explain:

Please name two people who will provide a letter of reference for you:


Name1:
Address 1:
Phone 1:
Name 2:
Address 2:
Phone 2:
Please describe your heart for the poor:
Have you ever been on a mission trip before?

List Organization:
Type of Mission:
Why do you wish to take an active part in this trip?

Health Information


Describe your present level of fitness and any physical limitations
How would you describe your health?

List any conditions you may have that would limit your ability to function on a mission trip:
Do you have any chronic illnesses?

If yes, please explain:
Please list your Physician and phone number:
Please list any medications you are taking:
List any known allergies to food/medications:
Date of most recent tetanus immunization:
Does your health insurance cover you overseas?

Insurance name:
Group or Policy #:

Financial


Are you able to pay the cost if you are unable to raise support?

Do you understand that both the deposit and final payment are NON-REFUNDABLE?

Interested in donating frequent flyer miles? Please provide carrier info.
  1. Everyone going on a trip is required to attend team training/ team building session/sessions in preparation for the trip
  2. You will be notified of your acceptance or non-acceptance for this trip
  3. By signing this application, I commit to supporting and following the leadership of this mission trip.
The funds required for this trip will be applied towards expenses for this particular trip and may include but is not limited to: airfare, food, transportation, lodging, country fees, country tax, etc. In the event there are leftover funds from your trip, by checking YES, you agree that these funds will be rolled over to Starve Poverty’s general fund during that fiscal year. *

APPLICANTS NAME
DATE:
If applicant is a minor, Parent or Guardian must review application and your signature is required below.
Relationship to applicant:


Trip Payment