Team Haiti-4-Jesus Trip application

Basic Information:

Name______________________________________
Home Address: Street____________________________________________________________________
City __________________________ State ____________________Zip____________________
Home Phone # (____)__________________________ Cell Phone # (____)__________________________
E-mail ________________________________________________________________________________
Date of Birth _____/_____/_____
Male___ Female___
Marital Status: Married ___ Single ___ Other ___________________________

Employment:

Occupation __________________________________________# of Years ____
Job Description__________________________________________________________________________
______________________________________________________________________________________
Would you like to work in this field on this mission trip? Yes ____ No ___ Other______________________

Prior Trip Experience:

Have you been on a mission’s trip before? Yes ___ No ___
If yes, name of organization you went on trip with:_____________________________________________
Length of trip(s) ______________________
List overseas experience, location, length, accomplishments_____________________________________
List you skills, or abilities__________________________________________________________________
Do you speak any Foreign languages? _______________________________________________________
How proficient are you in the language?_____________________________________________________

Interest in Team Haiti-4-Jesus:

Why are you interested in going on this mission trip?___________________________________________
______________________________________________________________________________________

Church you currently attend:

Name _______________________________Affiliation _____________________
Street _________________________City _____________________State ______
Zip___________ Phone (___) _____________ Email ______________________
Pastor’s Name _____________________________________________________
Other religious, civic, community activities have you been involved with ______________________________
________________________________________________________________________

Health:

I feel that my health is: Excellent ___ Good ___ Fair ___ Poor ___ Other ____________
Comments _________________________________________________________________________________
__________________________________________________________________________________________________

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