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Please fill out the form below.  If you leave this page, your responses will not be saved, so be careful!   Once submitted, your application will be transmitted to our office and a backup copy will be sent to your inbox.  The deadline for applications (along with 2 references) for our 2018 international trips is Oct 3, 2017!

    Choose Your Trip

    Which trip(s) are you applying for?
    Cambodia 2018Freiburg, Germany 2018

    If you've checked multiple trips above, let us know your preference.

    Information About You

    Full First Name

    Full Last Name

    Middle Initial

    Email

    Cell Number

    Date of Birth

    Do you already have a passport?
    yesno

    If you do already have a passport that will be valid for our trip, please provide your passport number

    Home Address

    Your major

    Year in School

    Tshirt Size
    SMLXLXXLXXXL


    Emergency Contact

    Emergency Contact Name

    Emergency Contact's relationship to you

    Emergency Contact's home address

    Emergency Contact's cell #

    Emergency Contact's email


    Application

    Have you been on a missions trip before?
    yesno

    If you have been on a trip before, please provide some brief details. (when, where, what did you do?)

    Are you dating anyone that also may be coming on this trip?
    yesno

    If yes, who?

    Why do you want to go on this trip?

    What do your parents think about you going on a missions trip?

    What do you hope to gain, learn, or experience through this trip? (Please list 2 or 3 personal goals.)

    Briefly share your spiritual history.

    How do you function as a member of a team? (i.e. Are you outgoing or reserved? Do you avoid conflict or confront it?)

    What strengths do you bring to the team?

    What are some areas in which you hope to grow through this project?

    In 50 words or less, describe the core message of the Gospel.

    Do you have any foreign language skills?
    yesno

    If yes, what language(s)?

    If yes, how fluent are you?
    verydecenta littleI can ask where the library is

    We often ask students to lead workshops or classes in different areas of expertise. Check any areas you'd be proficient in:
    EnglishMusicArtSportsOther (explain below)

    If you checked "other" please provide details:


    Brief Medical History

    (All information on this application will be kept confidential.)

    Are you currently under the treatment of a doctor?
    yesno

    Do you have any condition requiring special medical consideration?
    yesno

    Do you have a history of psychological or emotional disorders, or limitations?
    yesno

    Have you sustained any injuries that may limit your physical activity?
    yesno

    Are you on a special diet that has been prescribed by a doctor?
    yesno

    Have you had major surgery in the last 3 years?
    yesno

    If you answered yes to any of the above medical questions, please provide an explanation for each area.

    Please list all medications you use, providing information on dosage, frequency, and reason for usage.

    List any known allergies: This includes medicines (penicillin, aspirin, iodine, acetaminophen, etc...) foods (dairy, wheat, gluten, etc...) contact with substances (plants, soaps, latex, etc...) animal allergies, and insect bites or stings:

    Has an allergic reaction ever required emergency room care for you?
    noyes


    Commitment

    Do you understand that our preparation and training for this trip will require your full commitment?
    yesno

    Do you understand that if the total amount required for this trip is not in by the deadline date, you'll not be allowed to go?
    yesno

    Do you understand that once a plane ticket is purchased in your name, you are personally responsible for payment, regardless of any reason that would cause you to cancel your plans to participate in this trip?
    yesno

    I agree that my role on this trip is to be a representative of Christ. I will submit to the leadership assigned to my team and have an attitude of love and service for those around me.
    I agreeI disagree

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