TEAM HAITI 2017 Application
(Please feel free to type your answers onto the application without concern for changes in the formatting.)
PERSONAL DATA
Name: ______
Date of Birth: ______
Mailing Address: ______
Email Address: ______
Phone #: ______
T-Shirt size: ______
Emergency Contact’s Name: ______
Relationship to you: ______
Phone: ______
Email Address: ______
Do you have a passport? ______
If so, write your name exactly as it appears on the passport:
______
Passport # ______Passport Expiration Date:______
If not, what is the name that you will use on your passport:
______
It might be good for you to consider starting the process of obtaining a passport by going to :
EDUCATIONAL EXPERIENCE
Where did/do you attend school/college/post-grad? ______
Grade Level: ______
Work Experience: ______
CHURCH
Name and location of the church where you are a Communicant Member: ______
PASTORAL REFERENCE
Email and phone number of your pastor or a ruling elder who knows you well and is supplying a reference: ______
Your pastoral reference must be emailed or mailed by your pastor or elder at the same time as your
application to or 2131 Pound Dr., Placentia, CA 92870.
PLEASE ANSWER THE FOLLOWING QUESTIONS BRIEFLY:
1. Are your parents supportive of your participation with TEAM HAITI? ______
2. What are your reasons for wanting to be part of TEAM HAITI? ______
3. Please describe what it means to you to have Jesus as your Lord and Savior. ______
4. Please list ways in which you have served in your local church. ______
5. Sharing your faith will be an important part of the TEAM HAITI experience. Have you had
opportunities to witness to non-Christians? ______If “yes”, describe briefly. If “not yet”, are
you willing to prepare to share your faith while serving with the Team?
______
6. List skills you have that you think might be helpful to TEAM HAITI (teaching children, sports,
singing, musical instruments, arts & crafts, etc.)
______
7. Describe any cross-cultural exposure or missions team experience you have had (overseas or in the US)
______
8. Do you have any physical or medical conditions about which we should know? If so, please describe
below.
______
9. Do you have any food allergies? ______If yes, please list below.
______
10. TEAM HAITI will require very rough riding. Do you have any back problems? ______
11. TEAM HAITI costs are ~$1,750. This does not include the cost of processing a passport if you do not have one, the cost for medical shots as needed, and the cost for purchasing souvenirs. Is your Session
willing to encourage your church to financially support you in this ministry? ______
12. If you receive no financial assistance from your church, are you and your family able to pay for all your trip costs? ______
13. Haiti is sometimes an uncertain part of the world. Do you agree to abide by any precautions that the missionaries and team leaders deem necessary while traveling with the team? ______
TIMELINE:
- Application Due: February 25, 2017 Do not delay in sending in your application.
- Team Chosen & Notified: March 1, 2017.
- Team Confirmed/ $700 Fee Due Immediately on Notification: March 2, 2017.
Since tickets will be purchased IMMEDIATELY by the committee, if a team member should need to back out after he/she has confirmed, he/she will be responsible for any cancellation fees that may occur, which is usually the full cost of the ticket.
- Second payment of $500 is due April 15, 2017.
- Final $500 payment is due June 1, 2017.
- Gifts and Supplies for the Hopps estimated at $50.
- Team members will also need to see their doctor before going to Haiti in order to receive necessary
shots to avoid illness while there. Details will be forthcoming to those who are selected.
Application signature: I have read payment timeline and agree to meet each payment date to the best of
my ability.
Signed: ______
(If emailed typed signature is fine)