International Short Term Mission Trip Scholarship Request Form

International Short Term Mission Trip Scholarship Request Form
ACKNOWLEDGEMENT STATEMENTS:
I (the applicant) acknowledge and understand that to be considered for an International Short Term (1-2 weeks) Mission Trip scholarship an individual MUST meet the following criteria:
- The applicant must be a professing believer in Jesus Christ as their personal Lord and Savior.
- The applicant must be a member of a local church and in good standing.
- The applicant must currently serve in some capacity at their church of membership.
- The applicant must currently give financial offerings or tithe to their church of membership.
- The applicant must submit to the Baptist Faith & Message 2000 (membership to a Baptist or SBC church is not required).
I (the applicant) acknowledge and understand that at this time Coworkers Ministry is only able to offer scholarships to individuals who are at least 13 years of age by the date of departure. If under 18, parent or legal guardian information and signature must be completed on this application to be considered.
I (the applicant) acknowledge and understand that the decision to award any scholarship is based on several factors. Many of those factors are well beyond the information collected on this request form, and that simply submitting a request for scholarship is no gaurentee that a scholarship will be awarded.
I (the applicant) acknowledge and understand that Coworkers Ministry cannot be held liable for any injury, death, or loss that occurs as a result of the applicants willful participation in the mission trip for which this scholarship request is being submitted.
I (the Applicant) Acknowledge, Understand, Affirm and Agree to the Acknowledgement Statements Above

YESNO
Applicant Information

This is the individual who is actually going on the mission trip, and requesting the scholarship or seeking funding.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Age at Time of Mission Trip Departure*
Must be at least 13 to be considered. See Acknowledgement Statements.
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent or Legal Guardian Information

Only required if the applicant is under the age of 18 at the time of completing this application.
Parent or Legal Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number if different than applicant.
Parent/Guardian Email*
example@example.com
Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Church of Applicant
Church of Membership*
Date Membership Began*

MonthDayYear
Approximate Date that Membership Began is Acceptable
Senior Pastor/Preacher/Elder Name*

First NameLast Name
Church Phone Number*
Please enter a valid phone number.
Senior Pastor/Preacher/Elder Email*
example@example.com
Church Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do You Currently Serve Your Home Church?*
Mission Trip Details
Mission Trip Destination*
Organization Name*
Entity organizing the mission trip, typically your home church or the destination church/organization.
Planned Departure Date *

MonthDayYear
Departure date should be at least 90 from date of request. We hope you understand that funding takes time.
Planned Return Date *

MonthDayYear
Date
Total out of pocket cost that you are responsible for on this Mission Trip*
Include all transportation (flights, rental cars, taxis etc.), passport fees if any, lodging accommodations, and reasonable meals.
Requested Scholarship Amount for this Mission Trip*
Should be no more than 90% of the total out of pocket cost, and maximum of $2500.
Purpose of The Mission Trip?*
Why do you want to be a part of this mission trip?*
Skills or Experience Relevant to the Mission Trip*
Please verify that you are human*
Unfortunately, based on your response we are unable to continue with the scholarship application process at this time. We sincerely hope that you understand that our position is based on the belief that an individual must meet certain criteria in order to receive financial support from Coworkers Ministry.
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International Short Term Mission Trip Scholarship Request Form

ACKNOWLEDGEMENT STATEMENTS:

Applicant Information

Parent or Legal Guardian Information

Home Church of Applicant

Mission Trip Details