Application Form — Hope on the Ground

INDIVIDUAL APPLICATION FORM

Each participant in a Hope on the Ground short-term team must complete this form in advance. We will use your responses to try to plan the best possible experience for you and your team.

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 you are awaiting a new passport, please put 01/01/2000 as your expiration date.

YYYY

Citizenship

If "other" please specify citizenship:

T-shirt Size

Church Name and City

(if applicable)

HEALTH INFORMATION

Dietary restrictions:

Please list anything we should know about your diet, as we start planning some meals before you even arrive.

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. If you have any sort of medical background, please be specific about your area of expertise.

How are you involved in your community?

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

What else would be helpful for us to know so that we can best care for you during your time with us? Include any physical or emotional considerations such as recent personal traumas or losses, mental illness, and physical disabilities or difficulties, that might affect your time in country. In some cases, cross-cultural ministry can bring grief and other emotions to the forefront, and we want to support you the best we can!

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.