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Chi Alpha Mission Trip Application 2020
Thanks for showing interest in our Spring Break Missions Trips to Chicago and Jamaica!

Please fill this out as soon as possible.
**APPLICATION DEADLINES: These applications MUST be filled out by Tuesday, November 26th before you leave for Thanksgiving Break.

First Payment Due:
December 11th (Before leaving for Christmas Break)
*Jamaica $200
*Chicago $50

First Name *
Your answer
Last Name *
Your answer
Current Address *
Your answer
Phone Number *
Your answer
Email *
Your answer
Parents Name (Include at least one parent) *
Your answer
Parent's Phone Number *
Your answer
Indicate which trip you are applying for *
Do you currently have a passport with an expiration that extends 6 months after our return (6 months after March 14th, 2020)? *
Have you ever been on a mission trip before? If so, when and where? *
Your answer
Why do you want to go on a mission trip? *
Your answer
Why do you want to go to this location? *
Your answer
If there is no more room to the location you are applying for, would you consider the other trip? *
Your answer
Do you feel called to full-time ministry as a vocation in the future? *
Do you realize there are certain dangers related to this trip? *
Have you spoken to your parents about this trip? Are they in favor of you going? *
Your answer
How are you planning to raise the necessary funds to go? *
Your answer
Can you get the money in by the due dates? *
Your answer
Do you have any problems submitting to the authority of your Pastors and/or Interns? If so, explain. *
Your answer
When did you give your life to Jesus? Also, please briefly describe your current life with Jesus (ie. devotional life, spiritual growth, etc) *
Your answer
Which small group (if any) are you in? *
Your answer
Describe any gifts you have that you feel may contribute to this trip. (i.e. encourager, organizer, etc.) *
Your answer
List your strongest personal qualities. *
Your answer
List your weakest personal qualities. *
Your answer
Character Reference: Which Chi Alpha Staff Member would you say knows you the best? *
Emergency Contact (1) Name & Relation *
Your answer
Emergency Contact (1) Phone Number *
Your answer
Emergency Contact (2) Name & Relation *
Your answer
Emergency Contact (2) Phone Number *
Your answer
Do you have any food allergies/aversions that we need to be aware of? *
Your answer
Do you have any medical conditions or medications that we need to be aware of? *
Your answer
PLEASE INITIAL BELOW TO AGREE TO THE FOLLOWING: I understand there are limited number of spots for each trip, so it is possible that some qualified applicants, including myself, may not be able to go. I understand that the goal of UMD Chi Alpha is to protect the spiritual maturity and overall well-being of each person that applies, as well as to see that these teams bless and support the ministries UMD Chi Alpha is going to serve. I understand that the pastoral staff reserves the right to review all applications, request more information and accept/decline any application based on the pastoral evaluation of maturity, readiness and the best interest of the individual applicant and the team. *
Your answer
PLEASE READ THE LIABILITY WAIVER BELOW BEFORE SIGNING YOUR INITIALS: I am aware of the risks associated with participation in a short term missions trip. I hereby release UMD Chi Alpha, its agents, employees, and volunteers from any liability whatsoever arising from such risks including, but not limited to death or personal injury by sickness, disease, weather, terrorism, damage or theft which may be sustained by me as part of the Missions Trip to Chicago/Jamaica, sponsored by UMD Chi Alpha March 7th-14th, 2019. I do further give my consent to staff members and properly appointed volunteers of UMD Chi Alpha to administer medical treatment or medication to me in the case of an emergency. I further agree to the performance of treatment, anesthetics, and operations deemed necessary for me in the opinion of the medical personnel present. I understand that while I participate in any of the UMD Chi Alpha sponsored activities, I am responsible to abide by the rules set forth by UMD Chi Alpha, its agents, employees, and properly appointed volunteers. I understand that UMD Chi Alpha is a non-profit organization registered in the State of Minnesota and that due to IRS regulations, all contributions made to UMD Chi Alpha are non-refundable. (Giving statements will be issued at the end of the of the year.) *
Your answer
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