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Preferred Name
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Age
Gender
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I'd rather not say
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Citizenship
Country of Birth
Marital Status
Single
Married
Widowed
Divorced
Separated
Other
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
Month
January
February
March
April
May
June
July
August
September
October
November
December
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
Year
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Passport Number:
Email
Emergency Contact Person:
Emergency Contact Person Phone Number:
Beneficiary:
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