Application Form — Hope on the Ground

INDIVIDUAL APPLICATION FORM

Each participant in a Hope on the Ground short-term team must complete this form prior to their time in country. We use your responses to plan an experience that will take advantage of your unique gifts and skills.

Please note: You will need your passport number and expiration date to complete this form.

Team Name

PERSONAL INFORMATION

Name (as on passport)

First Name

Last Name

Goes By Name

Date of Birth

YYYY

Age, as of first day in country

Gender

Cell Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Passport Expiration Date

Your passport must be valid for 6 months past your date of entry into the country. If it is not, please apply for a new passport as soon as possible.

YYYY

Citizenship

If "other" please specify citizenship:

T-shirt Size

Church Name and City

(if applicable)

HEALTH INFORMATION

Dietary restrictions:

Please list only those that will affect your eating while in country.

Allergies:

Please list and indicate severity.

Medications:

Please list dosage and frequency.

Medical information:

Please share any medical conditions or other information we should be aware of.

Emergency Contact Information

Name

First Name

Last Name

Relationship to Participant

Cell Phone

(###)

###

####

Please type your initials to authorize e=h to contact and disclose medical information with the above person in the event of a medical emergency. (Parent or guardian please initial for minor participant).

CHARACTER INFORMATION

What is your profession?

Please list any skills, talents, or hobbies.

How are you involved in your community?

Why do you want to participate in a Hope on the Ground mission experience?

If selected for a Hope on the Ground experience, I will:

• Submit my personal desires (privacy, food, dress, etc) to the standards of the field. • Willingly obey my leaders throughout my Hope on the Ground experience. • Build up my fellow team members and ministry partners. • Participate in pre-field meetings and post-field meetings. • Remain alcohol- and drug-free during my Hope on the Ground experience.