Name *
Date of Birth *
Date of Birth
Cell Phone *
Cell Phone
Mailing Address *
Mailing Address
Primary Parent/Guardian Name *
Primary Parent/Guardian Name
Parent/Guardian Permanent Mailing Address *
Parent/Guardian Permanent Mailing Address
Parent/Guardian Cell Phone *
Parent/Guardian Cell Phone
Present Church Membership Address *
Present Church Membership Address
I understand the dates of service are June 10, through July 28, 2018. *
I have included references from: *
Select all that apply.
Have you ever been accused or charged with child abuse or a crime involving actual or attempted sexual molestation of a minor? *
The next questions are highly personal. This sensitive information will be handled confidentially by those who evaluate your application. As representatives of Christ to others, student missionaries must exhibit strong convictions and a life consistent with biblical standards. A past problem with illegal drug use and/or immoral relationships will not prevent you from being accepted provided: (1) it can be determined that convictions are strong and consistent with Scripture and, (2) a sufficient track record of Christian living has been established.
Have you ever been convicted of a felony or misdemeanor? *
Do you have any physical or emotional challenges that would hinder your service or placement as student missionary? *
Have you used illegal drugs within the past 12 months? *
Have you consumed alcohol within the last 12 months? *
Have you used tobacco products within the last 12 months? *
Have you engaged in sexual activity with anyone within the last 12 months? *
Have you intentionally viewed pornographic material within the last 12 months? *
Is there anything in your life, if made known, would hinder your witness or be an embarrassment to your ministry or the agency or group you represent? *