Dominican Republic Application | Grace Orlando | Non-Denominational Church in Central Florida

Full name (as it appears on passport) *

Do you go by another name than above? If so, what name? *

Birthdate *

Check one: *

Male

Female

Passport Number *

Passport Expiration Date *

Current Street Address *

City *

State

Zip *

Primary Phone *

Alternate Phone *

Email *

Emergency Contact Name *

Emergency Contact Relationship (e.g. spouse, relative, friend) *

Emergency Contact Email *

Emergency Contact Phone *

Which trip date are you applying for? *

SKILLS AND EXPERIENCE

Do you have skills that could be useful during this trip? (photography, medical, construction, etc) *

Do you speak a foreign language? *

Yes

If so, please list each language and proficiency:

PERSONAL MEDICAL INFORMATION

You may be serving in an environment that has limited health care resources. In order to provide for your health care needs and assure your medical safety, your team leader will bring your completed health form on the trip to use as a reference should you require medical attention. Therefore, we need your honest answers to the following questions. The information you provide will be kept confidential. Please use the back of the form to expand on any answer you need to. Once you are accepted you will be required to provide a more detailed health form.

Please tell us about your health, including any conditions that could limit your normal activities under day after day stressful situations:

Do you smoke?

If yes, how many packs/day?

For how long?

Do you exercise?

Type of exercise:

How often?

Please list any dietary restrictions (write none if none):

CROSS-CULTURAL EXPERIENCE

Have you ever participated in any kind of serving trip overseas? Explain. *

What are your reasons for wanting to go on this trip? *

What are you expectation for this trip? *

CHURCH EXPERIENCE

Do you attend Grace Orlando? *

Yes

If not, do you attend another church?

Yes

If you attend another church, which one?

Do you currently serve at Grace Orlando or elsewhere, and what is your role? *

How long have you been involved in this role?

SPIRITUAL LIFE

Please describe your spiritual journey in the last 6-12 months. What have you learned? Where have you struggled? What questions have you been wrestling with? Please answer all three questions in your explanation. *

Is there more of your personal story you feel it is important for us to know? Please explain: *

TEAMWORK

What part about working, eating, sleeping, traveling, playing, etc with a team of peers and leaders excites you? Worries you? *

Can you work well under someone else's authority, even if things aren't being run the way you think they should be? *

REFERENCES

List complete contact information for two personal/spiritual references. Please ensure that these references are aware of your application for this trip and that they will be contacted.

Reference #1 Name *

Email *

Phone *

Your relationship with this reference: *

Reference #2 Name *

Email *

Phone *

Your relationship with this reference: *