911 Life ITEC Application Form
This form is part of the application process for any of the training courses that are offered at the International Training and Equipping Center which is a ministry of 911 Life.

If the applicant has any questions they can contact us at info@911life.org.

Please be honest in your self evaluation.
Email address *
PERSONAL INFORMATION
First Name *
Your answer
Middle Name
Your answer
Last Name *
Your answer
What school are you applying for? *
Have you ever ministered with 911 Life or Tom and Jen Atwater in Medellin before? *
If you answered "yes", please explain in what capacity.
Your answer
Date of Birth *
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If the missions participant is a minor please write the father´s and mother´s names below with phone numbers and e-mail addresses.
Your answer
Gender *
Cell Phone Number *
Your answer
E-mail Address *
Your answer
What is your profession? *
Your answer
With what church/team are you coming? *
Your answer
HEALTH & INSURANCE INFORMATION
Do you have any diagnosed physical or mental health conditions? *
If so, please explain:
Your answer
Do you have allergies to food, medicine, etc.? *
If so, please describe.
Your answer
Please list any condition, physical disability, and or medication that may limit your participation during your time in Colombia.
Your answer
HEALTH INSURANCE IS REQUIRED FOR YOUR TRIP. Do you have primary medical insurance? *
If so, what is the name of your insurance provider and policy number?
Your answer
Does this insurance cover cases that occur internationally?
Do you have travel insurance that includes medical emergency coverage? *
If so, what is the name of the insurance provider and policy number.
Your answer
If not, you will need to purchase travel insurance that includes medical emergency coverage before you arrive. Please indicate below when you will send us the insurance company and policy number
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
What is your relationship to the emergency contact? *
Your answer
PASSPORT INFORMATION
Do you have a passport? *
What is your passport number? *
Your answer
Country of issue *
Your answer
When does your passport expire? *
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FAITH, CHURCH, & MINISTRY INFORMATION
Is Jesus your personal Lord and Savior? *
Have you ever had a personal encounter with the Holy Spirit? *
Do you participate in the gathering of a local church body in your area? *
Do you serve in a specific ministry at a local church body in your area? *
If so, in what ministry/ministries do you serve at this local church?
Your answer
SUPPLEMENTAL INFORMATION
What made you interested in this trip? *
Your answer
What are you most passionate about? *
Your answer
Do you have experience with children? *
Have you received any Christian ministry training? *
Do you have any specific talents/skills you would like to use on this ministry trip? *
If so, please explain.
Your answer
Do you speak Spanish? *
If so, what level?
Have you ever been convicted for any criminal offense? *
If so, please explain.
Your answer
TEAM MEMBER INFORMATION AGREEMENT
Please read the text below. The check box consitutes as your legal digital signature.
I affirm that the information provided by me in this form is true, correct and complete to the best of my knowledge. I authorize 911 LIfe to verify any and all information provided. I understand that if there are any false statements, omissions, or other misrepresentations made by me on this application, it may result in my immediate dismissal. *
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