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 Application - Better to Have One Emailed But Use This One If You Must Spencerville
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Do you like rice and beans?
Yes No Maybe
Full Legal Name:_________________________________________________ (if not you better learn to)
à (As is or will be on passport)
Address:________________________________________________________City ____________________________
State__________ Zip____________ Home Phone:______________________ Date of Birth: ___________________
School: ____________________________ Grade:
We send meeting reminders, updates and information as many ways as possible to keep you up-to-date. An email address you actually read is very important. Also we will send you texts but only of you say it is ok.
Student Email:_____________________________________ Cell #:______________________ OK to Text You: Y N
Passport: Yes No Expires: ____________ Issuing Country:_____________________Citizenship:_____________
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Parent / Guardian Contact Information |
Parent or Guardian’s Name: _______________________________________________________________________
Address: ______________________________________________________________________________________
(we’ll send
Home Phone:__________________ Email Address: _______________________________________ them info, too)
Cell Phone:______________/ ______________ Work Phone: _____________/_____________
(Mother / Father) (Mother / Father)
Non-Parent Emergency Contact Name: ______________________________________________________________
Address: ______________________________________________________________________________________
Home Phone:____________________ Cell Phone:__________________ Work or 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.
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Where do/have you worked and what are/were your duties? ___________________________________________________
_________________________________________________________________________________________________________
Why do you want to go on this trip? _________________________________________________________________
_________________________________________________________________________________________________________
What is the most important thing you will be able to contribute to this trip? __________________________________
_________________________________________________________________________________________________________
What things would you like us to do on this trip? _______________________________________________________
_________________________________________________________________________________________________________
Ministry Skills and Interests |
Rate your skill level in each area, first for the general ministry category (construction, personal, other) in an overall sense, then with the specific skills below the general category. Finally, 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
YOUR INTEREST RATING
YOUR SKILL RATING Doing Leading
[1-No, 2-Maybe, 3-Yes!]
Construction Ministry (in general) 1 2 3 4 5 1 2 3 Yes No
- 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
VBS/Personal Ministry (in general) 1 2 3 4 5 1 2 3 Yes No
- Sports Camp 1 2 3 4 5 1 2 3 Yes No
- VBS performing dramas & skits 1 2 3 4 5 1 2 3 Yes No
- VBS song service 1 2 3 4 5 1 2 3 Yes No
- VBS telling children’s stories 1 2 3 4 5 1 2 3 Yes No
- VBS crafts 1 2 3 4 5 1 2 3 Yes No
- Speaking for church 1 2 3 4 5 1 2 3 Yes No
- Singing as part of a choir 1 2 3 4 5 1 2 3 Yes No
- Special music for church 1 2 3 4 5 1 2 3 Yes No
Team Support & Other Ministry 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…)
- Medical team (1st Aid) 1 2 3 4 5 1 2 3 Yes No
- Organizing, details 1 2 3 4 5 1 2 3 Yes No
- Doing our daily blog 1 2 3 4 5 1 2 3 Yes No
- Videography & slide shows 1 2 3 4 5 1 2 3 Yes No
- Doing a worship for our team 1 2 3 4 5 1 2 3 Yes No
Other skills and interests you may be able use on this trip: ________________________________________________
______________________________________________________________________________________________
What instrument(s) do you play? ____________________________________________________________________
And would you be willing to bring that instrument(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 The Dominican Republic so he/she can continue the mission trip.
Ø B. Learn and respect the local law and culture of The Dominican Republic and be mindful of my witness at all times.
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.
_____________________________________________________________________________________________
Signature Printed Name Date
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Reference – Pastor |
As pastor at
______________________________________________________________________________________________
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 Dominican Republic Mission Trip.
______________________________________________________________________________________________
Signature Printed Name Date Phone Number
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Reference – Unrelated Adult |
I recommend the above student to participate in the Dominican Republic Mission Trip.
______________________________________________________________________________________________
Note on Deposits: Deposits are returnable only until November 1 and are transferable, with the approval of the mission team, until January 1. Applications received without deposits are not complete and not acted upon.
Once Fully Completed
Return with deposit to:
