Name:

Address:

City, State:

Zip:

Home Phone:

Cell Phone:

Email:

Age:

Year in school: (if applicable)

Education: (school names, degree earned, or degree working toward)

How do you practice your faith? What do you do in your life to deepen your relationship with God?

Why do you want to go on this missions trip?

What are your expectations for the mission trip?

Please describe previous mission work, if any.

Please describe previous EE or other evangelism training.

Please describe yourself.

Are you willing to raise funds for the mission trip?

Please tell us about any operations or serious injuries and dates:

Please tell us about any disability or chronic recurring illness:

Current medications:

Allergies and sensitivities (food, drugs, plants, animals, insects, etc.):

Health and dietary restrictions: