YA Mission Trip Interest Form
Thank you for your interest in missions!
Instructions:
Complete the interest form. This form is the first step in the application process.
You must be 18 to complete this form.
There will be several more forms to complete once you are approved by the screening committee.
Any international trip requires a passport number to complete and be considered for the trip.
Basic Profile Information
Tell us about yourself.
Are you a
*
Young Adult (18-25 years old)
Adult Leader (over 18)
Adult (more than 25 years old)
Pastor/Young Adult Director
Do you currently have a passport?
*
Yes
No
If yes, what is your passport id #?
Name
*
First Name
Last Name
Gender at Birth
*
Church Name / City
*
Best Phone Number to Reach You
*
Date of Birth
*
-
Month
-
Day
Year
Date
Age
*
E-mail
*
example@example.com
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Relationship to Emergency Contact
*
Do you hold dual citizenship?
*
Yes
No
If yes, where?
Please list any special skills, abilities, musical talents, etc., you may have.
*
Health Questionnaire
As we get closer to the trip, we may have more questions.
1. Are you in good physical health?
*
Yes
No
If no, please explain.
2. Do you have any physical handicaps?
*
Yes
No
If yes, please explain.
3. Will you be willing to eat whatever food you are served?
*
Yes
No
4. Do you have any known allergies, including food or medical?
*
Yes
No
If yes, please explain.
5. Are you currently taking any medications?
*
Yes
No
Spiritual Formation Questions
Tell us more about your walk with Jesus.
1. Have you confessed Jesus Christ as your Lord and Savior?
*
Yes
No
2. Have you been baptized in water?
*
Yes
No
3. Have you been baptized in in the Holy Spirit?
*
Yes
No
4. Describe your relationship with Jesus.
*
5. Describe your involvement in your local church.
*
Mission Trip Experience
Tell us more about your missions experience.
1. Have you ever participated in an AIM outreach?
*
Yes
No
2. If yes, what year(s) did you participate and where did you go?
Further Questions About Your Church Leadership
Lead Pastor's Name
*
How long have you known your pastors?
*
Certification of Truth
By signing below, I certify that all of the above information is true, and I have answered each question completely and honestly. I also understand that my application will be sent to a screening committee for approval and any applicable fee is non-refundable.
Applicant Name (please print)
*
Applicant Signature
*
Date
*
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Month
-
Day
Year
Date
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: