Send Me Refuge - Mission Application

First Name

Last Name

Preferred Name

Email

Phone Number

Work Phone Number

Birthdate

Age

Gender

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Citizenship

Country of Birth

Reason for Other:

Is your spouse supportive of your participation in this mission trip?

Yes

No

Does Not Apply

Do you have an up to date passport?

Yes

No

If you answered NO to the question above, please apply for your passport. Once you have received your passport number, please give your number to your team leader or directly to Annette Hand at annette@sendmerefuge.com.

Name as it appears on your Passport

Passport Number

Issue Date

Expiration Date

City and State where issued

Have you ever been convicted of a felony?

Yes

No

Details of Felony

Please answer all questions honestly and personally.

Describe your life before you repented of your sins and accepted Jesus Christ as your Lord and Savior:

Describe your walk with the Lord at this present time. ( Please be honest, we do not want to put you in any situation that you don't need to be in while in the missions field.)

In what areas of your life have you seen spiritual growth over the last days, months, years?

Briefly explain why you desire to go on this mission trip:

How do you see God calling you to participate on this trip?

What type of skills and/or spiritual gifts/ talents do you have?

Current church attending and/or membership:

How long have you been attending and/or a member of said church?

List the ministries you have been involved with at your church or outside the church (please include time of involvement and any leadership positions held):

Have you had training in personal evangelism?

Yes

No

Maybe

Have you been on a short-term missions trip before?

Yes

No

Maybe

Please list the country, missions organization, dates, and ministry purpose please:

Please list any foreign language training and your level of proficiency:

Briefly tell me about yourself (strengths, weaknesses, spiritual gifts, talents, skills, trade, occupation):

How would you describe your present health?

Please list any major illnesses you have had in the last five years:

Are you currently under the care of a physician?

Yes

No

Please explain:

Please list all medications you are currently taking:

Please list all food, medicine, etc. ALLERGIES you have:

Please explain any physical challenges that you may face on this mission trip:

Primary Emergency Contact:

Relationship to you:

Phone Number

Email

Secondary Emergency Contact:

Relationship to you:

Phone Number

Email

Travel insurance (through Missionary Travel Agency) will be purchased while you are abroad for your mission trip with Send Me Refuge. AS LISTED ON YOUR PASSPORT

First Name:

Middle Name:

Last Name:

Birthdate

Passport Number:

Email

Emergency Contact Person:

Emergency Contact Person Phone Number:

Beneficiary: