2018CambodiaMission Trip

APPLICATION FORM

E-mail your completed application form and a copy of your passport to . Husband and wife must submit separate forms. Mission trip fee is $1350 excluding airfare and tourist visa.

Personal Information

Name ______

Mr./Mrs./Miss/Ms.First Middle Last

Current Address ______

Street address or P.O. Box number

______( ) ( )
CityState/ProvinceZip/Postal codeHome PhoneCell Phone

E-mail ______

Full Name (as written in passport)______

Date of Birth Country of Birth ______Citizenship ______

Passport Place of Issue ______Issue Date ______Expiration Date ______

Passport Number ______Airline and FlightNumber ______

Emergency Contact ______

NameRelationship to you

______

Street AddressCityStateZip/Postal Code

( ) ( ) ______(____)______

Home Phone Work Phone Second Contact Phone

Please provide (or call in) your credit card information if you are interested in getting a tax break on your airfare:

______

Name as it appears on credit card

______

Card TypeCard Number Expiration dateCVC Code

General Information

Have you ever served with ASAP before? Yes No When and Where?______

How did you hear about this mission trip?______

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Education and Experience Information

What is your current occupation? ______

List any specialized skills, training or certifications. ______

What is the highest level of education you have attained? ______

What college, if any, did you attend/are you attending? ______

Major Purpose of Study ______

Foreign Language(s) ______Years Studied ______

Verbal Ability: __Beginner __Understand some __Able to respond sometimes __Advanced __Fluent

Briefly describe any overseas travel experience you have had. ______

______

______

Have you raised financial support in the past? ___Yes __No

If you are hesitant or unable to raise financial support through your church, will you have the means to pay for this trip yourself? __Yes __No

Christian Life Information

Are you a baptized member of the Seventh-day Adventist® Church? __Yes __No

What is the name of your church? ______

What is your pastor’s name? ______phone ______E-mail______

List and comment on your three greatest personal strengths and weaknesses.

Strengths

1.______

2.______

3.______

Weaknesses

1.______

2.______

3.______

Do you have previous mission experience? If yes, in what ways have you served?______

What do you feel that you can contribute to a team by way of abilities or talents:

Children’s Ministries MedicalDental Health Lecturer Youth Ministry Teaching Evangelism PreachingMusic Accounting Office Administration Videography Photography

Other ______

If you indicated teaching, what subjects are you knowledgeable in? ______

If you are physician or a nurse, what is your specialty? ______

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Which team would you be interested in serving on (mark all that apply)?

____ Medical Team ____ Dental Team ____ Assisting with Children’s Programs

____Interviewing students (you willneed to bring a laptop computer and be able to use Microsoft Word)

Have you discovered what spiritual gift(s) God has given you? If so, how has this been demonstrated?

______

Briefly describe any Christian ministries you have been or are currently involved with.______

______

Answer the following on a separate sheet of paper.

  1. In 50 words or less, what do you hope to gain from this mission trip?
  2. Mission trips rarely go smoothly as planned. In 50 words or less how do you deal with stress and conflict?

Statement

I am looking forward to being actively involved in this mission trip and am willing to follow the directions of the mission trip leadership in following their guidelines and assigned tasks. I do understand that there is insurance coverage through Adventist Risk Management. Beyond what the insurance covers, I will not make ASAP Ministries liable for any sickness, accident, disease and/or death. I authorize ASAP Ministries to use any pictures or video of me in their publications or website.

I have read and agree with the statements mentioned above and pledge to give my full participation and cooperation in this mission trip by submitting this form via e-mail and sending in themission trip fee.

Your Signature:______Date:______

For the Travel Insurance Policy, please provide the following:

Outbound Flight Return Flight

AirportAirport

of Departure: Date:of Departure: Phnom Penh (PNH)Date:

AirportAirport

of Arrival: Phnom Penh (PNH) Date:of Arrival: Date:

Checklist

Before mailing your application, have you:

____ Completed and attached all essay questions on a separate piece of paper?

____ Included a check or money order for the application fee?

E-mail completedApplication Form to:

Mail $1,350 Mission Trip Fee to:

ASAP Ministries

2018CambodiaMission Trip

PO Box 84

Berrien Springs, MI 49103-0084

Phone: (269) 471-3026

Website: of 3