Global Encounters Application

Basic Information

First Name

Last Name

Email

Cell Phone Number

Home Phone Number

Age

Address

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Dorm

Room Number

MBU Box #

Academic Year

College Major

Is this trip fulfilling an internship?

YesNo

If so, what internship?

Passport Information (if available)

Full Name (as stated on passport)

First Name

Last Name

Passport Number

Issuing Authority

Date of Birth (MM/DD/YYYY)

Place of Birth

Date of Issue (MM/DD/YYYY)

Date of Expiration (MM/DD/YYYY)

Emergency Information

In case of emergency, please contact:

Contact Name

First Name

Last Name

Relationship

Phone Number

Email

Ministry / Spiritual Information

In what areas of Christian service are you currently involved?

In what areas of Christian service do you have previous experience?

If you have traveled on a mission trip in the past, please describe your experience.

Why do you want to participate in this mission trip?

Describe special skills (construction, music, sports, etc.) you have.

What foreign language abilities do you have?

How have your parents counseled you regarding taking this mission trip?

What do you perceive as the greatest challenges regarding taking a summer mission trip?

At this point in your life, what do you feel God calling you to do?

What do you feel is your greatest strength?

What do you feel is your greatest weakness?

Health Information

All information contained here is confidential. Answers given will be used for consideration for your health and safety.

Please note any dietary restrictions or food allergies (if applicable):

Please note any allergies to medications (if applicable):

Please list all medications, vitamins, and nutritional supplements that you regularly take, with or without a prescription:

List any ongoing problems which are being monitored or for which you are receiving treatment:

Have you ever been treated by a psychiatrist/psychologist for any reason?

YesNo

If yes, please explain.

Do you have any physical conditions that require special housing arrangements?

Check out this site for further information about health concerns for Americans living abroad, including what vaccinations you will need for the region to which you are going. http://wwwnc.cdc.gov/travel/destinations/list.aspx

Financial Information

How much school debt do you currently have, including any loans outside of Maranatha?

Would participating in this trip in any way prevent you from returning to MBU next fall? Explain.

Personal References

Home Church

Home Church Phone

Pastor's Name

First Name

Last Name

Home Church Address

Street Address

City

State / Province / Region

Zip Code

Country

Please provide a personal reference from a staff/faculty/administrator at Maranatha.

First Name

Last Name

Consent to: Medical Terms and Conditions

I do hereby recognize that traveling itself and specifically traveling to international destinations carries with it risk and danger, even possibly serious injury or death. Recognizing that these dangers exist, I am willing to assume that risk and proceed to travel with Global Encounters from Maranatha Baptist University with informed consent. I hereby release Maranatha Baptist University from any and all loss and/or damage that I may incur. In case of an emergency, I understand that every effort will be made to contact the parent/guardian. In the event the parent/guardian cannot be reached, I hereby give my permission to the physician(s) selected by the Global Encounters Leader of Maranatha Baptist University to hospitalize and secure proper treatment.

In providing this application, I realize that I am taking the first step forward toward traveling abroad this summer. If selected to travel this summer, I am willing to the best of my ability to participate in all team building activities throughout second semester. I am also willing to actively seek to raise my own funds and assist in team fundraising in accord with the leadership’s direction. I will also commit to pray faithfully about my involvement with the team this year.

Signature (initials)