MISSION TRIP APPLICATION

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Application to serve overseas for a short-term or a long-term period of time

PERSONAL INFORMATION

Name *

Date of Birth *

YYYY

Complete Address: (City, State, Zip Code, Country) *

Phone (including international code if outside the USA) *

email *

Country(s)/region(s) where you are interested in serving: *

Length of time you are able to commit *

PROFESSION / EDUCATION

Occupation or Title *

Specialty if applicable

Current Employer *

Professional License (if applicable)

List below all the schools attended and degrees earned (Please include years) *

Special professional training, skills and/or hobbies

Volunteer work / community affiliation

Languages spoken

SPIRITUAL INFORMATION

Name of church you attend *

Are you a member? If yes, since when? *

Past mission trips and length of trips

Type in below a brief testimony of your spiritual walk *

Describe your desire to serve overseas *

Have you ever been convicted or plead guilty or no contest to any criminal offense? If yes, please explain *

Any known physical or mental health issues that would prevent you from being able to fulfill your commitment in a sometimes physically demanding, high stress environment? If yes, please explain *

Please provide the name, titles, email and phone number of two references: one professional and one church leader *

By typing my name below, I acknowledge that the information contained in this application is correct to the best of my knowledge. I have not knowingly withheld any fact or circumstance that would unfavorably affect my application. I authorize Health Outreach to the Middle East (HOME) to verify information listed herein such as employment, church affiliation and references. I hereby release HOME and its agents from any and all liability arising there from. *

Thank you for your interest! Someone will contact you within a few days.

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