WMA Associate Missionary Application Form

Name *

First Name Last Name

Email *

example@example.com

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

If outside the U.S., list country:

Phone Number *

Area Code Phone Number

Date of Birth: *

Place of Birth: *

Country of Citizenship: *

Marital Status: *

Single Married Divorced Widowed

If you are married and/or have children, please list your spouse and/or children's names and birth dates:

Your permanent address in the U.S. (if applicable and different than above):

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Who is your closest living relative other than your spouse? Type their name and relationship to you: *

Please list their address, telephone number and email: *

Type your personal address overseas, if different than listed above.

Pastoral Reference: *

First Name Last Name

Please type the name of his/her church, address, telephone number and email: *

Character Reference: *

First Name Last Name

Please type their address, telephone number and email: *

Name of the ministry/missionary you will be working with on the mission field: *

Link to their website or social media page: *

Country where you are/will be living on the field: *

Do you consider yourself a long-term or short-term missionary: *

Long-term (more than one year) Short-term (less than one year)

If you are not currently on the field, when do you plan to depart? *

Please give a brief overview of the mission work you are/will be doing in this country with this missionary/ministry: *

What are the goals for the future of your missionary work? *

What is the estimated monthly budget that you have determined is required for you to live and operate on the mission field in U.S. $ amount. *

How do you plan to raise funds for your support? *

What is your highest level of completed education: *

High School Associate Diploma/Degree Bachelor's Degree Graduate Degree

Please list colleges and universities you have attended, dates, degree/diploma earned. Also, please list any School of Missions Training courses/schools you may have completed. *

Please list past missionary work/outreach trips. *

Have you ever been convicted of a crime? *

Yes No

If you answered yes, please list dates and details below:

Are you a licensed or ordained minister? *

Yes No

If yes, please list the name and address of the organization with whom you are affiliated:

Name, Address and Email of a contact person. (Someone other than yourself handling your mail/finances, and we can contact in case of an emergency.): *

Please handle my monthly deposit the following way: *

Electronically deposit to my bank account in the U.S. Mail check to contact person in the U.S. Wire Transfer to bank account overseas (extra fee charged)

How did you hear about World Missions Advance and/or who recommended World Missions Advance to you? *

The information given on this application is true and correct to the best of my knowledge. I authorize the deduction of 5% be taken from my monthly income through the World Missions Advance Associate Missionary program. I realize that the monthly fee is independent of any pledges or donation I might specify to other ministries/missionaries. I understand that an additional 2.5% fee will be deducted on credit/debit card and ACH donations and I authorize these deductions. Also, I authorize any deductions to be taken from my monthly income for the costs of printing and postage for monthly newsletters sent out at my request by the staff at World Missions Advance. I understand that I will be notified in advance of the estimated costs for this service. I also authorize the deduction of any wire transfer fees that incur, if I have my deposits wired to an international bank or financial institution. I also understand that all donations sent to WMA designated for me will be reported to the IRS as income, and I will receive a 1099 form at the end of each year. I commit to sending WMA a monthly newsletter or quarterly report of my ministry on the field; and an annual financial report showing how the donations are used. I also understand that information from my reports and newsletters may be used in a WMA newsletter, website or Facebook to highlight the Associate Missionary Program. By clicking YES, I am agreeing and confirming all of the above, *

YES NO

Signature *

Clear

Date *

Date