BOMBO 2018 Application
In September 2019, we will conduct our twelfth medical outreach clinic at the Bombo Pentecostal Church in Bombo, Uganda. The trip is August 28-September 7. An optional safari experience is available following the medical clinic, which is highly recommended for debriefing the previous weeks’ experiences. Travel takes two days on the front end of the trip, and one at the end of the trip.

The following application is designed for you to evaluate your interest in serving with Peninsula Community Church this summer in Uganda. It is also designed for us to get to know you a little better, to hear your heart and hear what God has been doing in your life. Please take the time to prayerfully complete and return this application to us as soon as possible.

Please fill out ALL QUESTIONS completely.

If you have any questions, email jim@pccpv.org

Email address *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Phone *
Your answer
Address *
Your answer
Passport Number *
Your answer
Passport Issue Date *
Your answer
Passport Expiration Date *
Your answer
Passport Place of Issue *
Your answer
Emergency Contact (Name and Phone) *
Your answer
I plan on attending the two-night safari (approx. $800) after the clinic, returning to LAX on Sep. 11 *
TEAM ROLE
Medical/Dental Certification, Experience, Specialties
Your answer
Note:
Doctors are required to obtain a Uganda medical license. This process should begin as soon as possible, more information will be send upon review of application to those with medical credentials.
Please rank your top three areas of service for BOMBO 2019 (descriptions of each area are in the info packet):
1
2
3
Doctor, nurse, medical personnel as certification stated above
Public health education
Pharmacist or pharmacy operations
Storage container operations
Research and data collection
Team support (runner, location as needed)
Please explain the reasoning for your first choice:
Your answer
SHORT ANSWER QUESTIONS
Please complete ALL questions with comprehensive answers.
Why do you want to be a part of this trip? *
Your answer
Have you been involved in any other mission/service project(s)? If so, briefly describe the experience(s). *
Your answer
What are some of your expectations, fears and apprehensions about going to Uganda to serve? *
Your answer
What do you think are some of your strengths, abilities, gifts, or experiences that would be a benefit to our trip? *
Your answer
What do you consider your greatest weakness? *
Your answer
Are you involved in a church? If yes, which church and if applicable, where do you serve? *
Your answer
Describe your relationship with Jesus Christ. *
Your answer
What is one thing God has been teaching you recently or what is one area you hope to grow in? *
Your answer
Please provide a reference we may contact (name and email/phone) *
Your answer
Participation Agreement: *
Required
Application Verification: *
Required
A copy of your responses will be emailed to the address you provided.
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