Short Term Missions Trip Application
Information you will need at hand to complete this application:
Passport (if you have one)
Emergency Contact Info.
Contact Info. for 3 References
Trip you are applying for:
Select a trip
Ethiopia - July 12 - July 21, 2008 - CLOSED
Ethiopia - Fall 2008 Womens Trip - CLOSED
Ethiopia - January 17 - 26, 2009
Guatemala - July 17 - 21, 2008 - CLOSED
Guatemala - October 9 - 13, 2008
India - January 15 - 31, 2009
PERSONAL INFORMATION
Name
(as appears on passport)
:
First:
Middle:
Last:
THE NAME YOU ENTER ON THIS APPLICATION MUST MATCH YOUR COMPLETE
NAME ON YOUR PASSPORT FOR AIRLINE TICKETING PURPOSES
Address:
City:
State:
Zip:
Phone Numbers:
Home:
Work:
Cell:
Email Address:
Confirm Email Address:
Age:
Date of Birth:
mm/dd/yyyy
Do you have a Passport?
Yes
No
Passport Number:
Expiration Date:
mm/dd/yyyy
Marital Status:
Gender:
Male
Female
EMERGENCY CONTACT INFORMATION
Emergency Contact:
(someone not traveling with you)
Relationship to you:
Address:
City:
State:
Zip:
Phone Numbers:
Home:
Work:
Cell:
CHURCH INFORMATION
Do you attend Living Word?
Yes
No
If yes:
How long have you been attending?
Are you involved in a Growth Group?
Yes
No
Your Growth Group Leader:
Ministries presently involved in:
If no:
Do you attend another church?
Yes
No
Church Name:
Church Phone:
Describe your relationship with Christ:
Briefly describe your motivation for applying for this trip:
MEDICAL INFORMATION
How would you describe your present health?
Excellent
Good
Average
Poor
Please describe any physical disabilities:
Current illnesses or conditions:
Current prescription medications:
Please list any allergies:
Please list any medications you are allergic to:
EXPERIENCE
Have you ever been on a short-term missions trip before?
Yes
No
If yes, where and what you did:
Have you ever traveled overseas before?
Yes
No
If yes, where:
Share any cross cultural ministry experiences:
Please list all professional skills:
Please list any languages you speak fluently:
REFERENCES
Reference 1
Name:
Email:
Phone:
How long have you known this
person and in what capacity?
Reference 2
Name:
Email:
Phone:
How long have you known this
person and in what capacity?
Reference 3
Name:
Email:
Phone:
How long have you known this
person and in what capacity?
Comments/Questions:
Living Word Community Church
2530 Cape Horn Rd. Red Lion, PA 17356
Get Directions
Phone: 717-848-4293
