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 Application Form -- Better if you have us e-mail you one but this will do Spencerville
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Student Information |
Do you like rice and beans?
(if not you better learn to)
Address:___________________________________________________________________________
Home Phone:________________________________ Cell Phone:_____________________________
Student’s Email:______________________________________ Date of Birth: ___________________
Passport: Yes No Expires: _____________ Issuing Country:________________________
Citizenship:
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Parent / Guardian Contact Information |
Parent or Guardian’s Name: ___________________________________________________________
Address: __________________________________________________________________________
Home Phone:________________________________ Cell Phone:_____________________________
Alternate Phone: _________________________ Email Address: _____________________________
Non-Parent Emergency Contact Name: ___________________________________________________
Address: ___________________________________________________________________________
Home Phone:_____________________ Cell Phone:_______________ Alt Phone:_________________
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Ministry Background |
Tell us about any outreach ministries (including mission trips) you have been involved with and what leadership positions have you held in school or in church.
__________________________________________________________________________________
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Why do you want to go on this trip? _____________________________________________________
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What is the most important thing you will be able to contribute to this trip? _______________________
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What things would you like us to do on this trip? ___________________________________________
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Ministry Skills and Interests |
Rate your skill level in each area – then tell us if you are interested in this area of ministry.
1 = Never done this 2 = Done it but not much or not very skilled 3 = Have pretty good knowledge of it
4 = Done it before & can do it again with little help 5 = All over it! Do this all the time
INTERESTED IN
Doing Leading
[1-No, 2-Maybe, 3-Yes!]
Masonry 1 2 3 4 5 1 2 3 Yes No
Carpentry 1 2 3 4 5 1 2 3 Yes No
Drywall 1 2 3 4 5 1 2 3 Yes No
Electrical 1 2 3 4 5 1 2 3 Yes No
Plumbing 1 2 3 4 5 1 2 3 Yes No
Painting 1 2 3 4 5 1 2 3 Yes No
General mechanical (fixing things) 1 2 3 4 5 1 2 3 Yes No
Medical Team (1st Aid) 1 2 3 4 5 1 2 3 Yes No
Sports Camp 1 2 3 4 5 1 2 3 Yes No
Worship talks 1 2 3 4 5 1 2 3 Yes No
Giving a testimony 1 2 3 4 5 1 2 3 Yes No
Health/healthy living instruction 1 2 3 4 5 1 2 3 Yes No
(dental care, HIV prevention…)
Leading group games 1 2 3 4 5 1 2 3 Yes No
Drama, skits, performing 1 2 3 4 5 1 2 3 Yes No
Drama, skits, writing 1 2 3 4 5 1 2 3 Yes No
Telling/teaching children stories 1 2 3 4 5 1 2 3 Yes No
Vacation bible school, crafts 1 2 3 4 5 1 2 3 Yes No
Organizing, details 1 2 3 4 5 1 2 3 Yes No
Song service 1 2 3 4 5 1 2 3 Yes No
Performing special music 1 2 3 4 5 1 2 3 Yes No
Other skills and interests you may be able use on this trip: _____________________________________
____________________________________________________________________________________
Do you play an instrument, if so, which one(s)?____________________________________________
My desired ministry mix is: (place X in scale) |___________________________________________________________________________________________| 100% Construction 50/50 100% Personal/Spiritual
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Agreement and References |
Applicant’s Mission Trip Agreement
I pledge to
Ø A. Respectfully obey all rules, accept the authority of the adult leaders and behave myself in a manner consistent with a Christian on a mission trip, or I will be returned home accompanied by a chaperone. I further understand that my parents will pay for my ticket, pay for the chaperone's ticket AND pay for a ticket to return the chaperone to Belize so he/she can continue the mission trip.
Ø B. Learn and respect the local law and culture of
Ø C. Keep a positive, cheerful attitude, and remember the goal of this trip is to serve and minister to others. I will serve when, and in the way, asked of me without complaining or delay.
Ø D. Uplift my fellow students -never putting them down, experience fellowship and Christ-like community with them, while refraining from any public displays of affection and avoiding the appearance of evil by staying together as a group.
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Signature Printed Name Date
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Reference – Pastor |
As pastor at
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Signature Printed Name Date Phone Number
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Reference – School Staff |
As a ___________________ at ________________________________ , I recommend the above student to participate in the Belize Mission Trip.
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Signature Printed Name Date Phone Number
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Reference – Unrelated Adult |
I recommend the above student to participate in the Belize Mission Trip.
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