Spring Break New York Application

Name:
Home Phone 888-888-8888):
Cell Phone (888-888-8888):
Address:
City:
State:
Zip:
Campus PMB:
Campus Residence:
Date of Birth (mm/dd/yyyy):
Marital Status:
Email:
Contact in case of Emergency
Contact Phone #:
Contact Address:
Contact City:
State:
Contact Zip:
Emergency Contact Zip:
Health Insurance Policy:
Company:
Policy Number:
Church Membership:
Church Address:
Church City:
State:
Church Zip:
Will this church help support you financially for this trip?:
Yes
No
How else do you plan to raise funds for this trip?:
Have you ever been on a mission trip before? If so, where?:
What were your responsibilities?:
Have you ever shared with another person your Salvation experience?:
Yes
No
Are you willing to attend all the orientation sessions to prepare for this trip?:
Yes
No
Do you speak any other language?:
What are some of your talents and abilities which you think will be beneficial to this team?:
Briefly give your testimony in a short paragraph.:
How did God speak to you about being a part of this mission trip?:
What do you hope God will do in your life while on this trip?:
I have read the qualifications and filled out this application to the best of my ability:
I agree:
Yes
No
Please email a copy of your schedule along with your application so that a meeting time can be planned.