Trip Application

Please fill out the application below to be considered for a Teach to Transform partner trip. All fields of information are required. If you desire, you may click here to download our Trip Application (an Adobe Acrobat PDF). Instructions for filling it out and returning it to us are included in the document.

Your Personal Details

Please provide information below EXACTLY as it appears on your passport.
First Name:
Middle:
Last:
Address:
City:
State/Province:
Postal Code:
Country:
Home Phone:
Mobile Phone:
Work Phone:
Your Email Address:
Date of Birth:
Month
Day
Year
Marital Status:
Gender: FemaleMale
Passport Number:
Passport Expiration Date (mm/dd/yyyy):
Do you have a criminal record: YesNo

Mission Trip Details

Application for the mission team to:
Previous short-term mission experience:
List any special abilities or skills that would be helpful to this mission (e.g. music, construction, teaching):
If accepted, do you have any concerns regarding being part of the team or nature of the mission?

Spiritual Life

Describe your present relationship with Jesus:
Where do you attend church?
Explain why you want to participate in this mission:

Medical Information

Describe your general health condition. Be sure to include any specific medical conditions:
List the medications (especially prescriptions) that you take (generic name, strength, and frequency of dosage):
Known Allergies:
Personal Physician’s Name and Phone Number:
Do you have any concerns regarding your health and traveling in a third world country?
If you do not have health insurance, you may acquire short-term mission health insurance. This provider is not affiliated with Teach to Transform. We are providing this link as a resource.
Name of Insurance Provider:
Policy Number:
Blood Type:

Finances

Are you willing to take responsibility for raising the necessary funds for the trip? YesNo
Do you need some ideas on how to raise support? YesNo

Emergency Contact

In the event of an emergency, whom should we notify: 
Name:
Email:
Telephone:
What is this person's relationshp to you?:

References

If this is your first short term mission trip with Teach to Transform, list two individuals who are willing to provide a character reference who are not family members.
Reference #1 Name:
Reference #1 Telephone / Email:
Reference #2 Name:
Reference #2 Telephone / Email:
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