Mission Application

14%

PERSONAL INFORMATION
Today's Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Cell Phone*
Email*
Gender*
Birthday*
MM
DD
YYYY
Do you speak another language?
What language?
Home Church*
Church City*
Church State*
Pastor's Name*
First Last
Do you have a passport?*
Marital Status*
Spouse's Name*

EMERGENCY CONTACT INFORMATION
In the unlikely event of an emergency in Guatemala, please list two emergency contacts (preferably stateside/no one on your team).
Emergency Contact #1*
First Last
Relation*
Cell Phone Number*
Emergency Contact #2*
First Last
Relation*
Cell Phone Number*
ALLERGIES/MEDICAL INFORMATION
Do you have any chronic illnesses, mental health issues, food allergies, physical limitations or any other special dietary needs?*
If yes, please explain.
Are you on any daily medications?*
If yes, please list.
Do you struggle with any type of addiction to alcohol or drugs?*
If yes, please explain.

INTERN INFORMATION
What do you think would be your greatest STRENGTH in serving as a Guatemala intern?
What do you think would be your greatest WEAKNESS in serving as a Guatemala intern?
What special skills/talents/abilities do you have to contribute? Please list.

APPLICANT AFFIRMATION
Consent to Comply*
Statement: The information contained in this application is correct to the best of my knowledge. I authorize any churches or other organizations listed in this application to give you any information they may have regarding my character and fitness for working with TCCI. I release all such references from liability for any damage that may result from furnishing such evaluation to you. I understand that any omission of material fact on this application may be grounds for rejection of this application. Should my application be accepted, I agree to follow the policies of Teams Commissioned for Christ International organization. By signing this form you are in agreement with the above statement and confirm that all information is true and accurate.

PERSONAL INFORMATION