City: State: Zip Code:
Home Phone: Date of Birth (m/d/y):
Work Phone: Social Security Number:
Cell Phone: Beneficiary:
1. State in a few paragraphs HOW and WHEN you came to have a relationship with Jesus
2. Why do you want to be a part of this trip and the team that is going from
3. What do you think are the strengths that you can add to this team?
4. What are your weaknesses? ("In your weakness, He is strong…" II Cort. 12:9)
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5. Evaluate yourself in each of the following areas by circling the number that best represents
Excellent Needs Improvement
Relationship to the Lord 4 3 2 1
Flexibility with people 4 3 2 1
Leadership potential 4 3 2 1
Patience with others 4 3 2 1
Respect for authority 4 3 2 1
Sensitive to others' needs 4 3 2 1
Ability to work hard 4 3 2 1
Responsible 4 3 2 1
Servant's heart and attitude 4 3 2 1
6. What do you expect to learn from attending this missions trip?
7. List some ways in which you believe this trip will enable you "bring something back" to
help other students at
8. Are you willing to spend the needed time in preparation, prayer and Bible study to prepare
for this trip? Why do you think that this is important?
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Missions Trip Commitment
"I desire to begin the process of being a part of this missions team. I will apply myself to this work in a serious manner, and I understand that I must attend the meetings needed to prepare for this ministry. I know that at a later time, I will be asked to sign a pledge dictating the purpose and expectations of behavior for this trip."
Missions Trip Team Member Date
Parent or Guardian of Team Member Date
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