Please fill out this application, in its entirety, for the Spring Break 2011 Mission Trip.

The deadline for submitting this application is November 1, 2010.

Name:

School Address:

School Phone:
() -
Email:

Home Address:

Home Phone:
() -
Parent/Guardian Name(s):

Parent/Guardian Email Address:

Church Membership (if applicable):

College/University:

Major:

Career Goal:

What volunteer and/or mission trip experience (domestic or foreign) have you had?

What attracts you to this particular mission trip?

What do you hope to give and to gain from this mission trip?

What specific skills, gifts, or talents do you have that might be helpful on this trip? Examples: speak Spanish, paramedic or first aid training, musically inclined, etc.

Name a reference and provide a means of contacting them:

Name a second reference and provide a means of contacting them:

All mission trip participants are required to attend at least one meeting and the overnight retreat as specified in in the brochure/website. Additionally, participants must receive all Center for Disease Control advised immunizations for travel in the country where they will serve, obtain travel health insurance, and secure an up-to-date passport. Participants who cancel on a trip after airline tickets are purchased will be responsible for the payment of that ticket.
Are you willing to meet these requirements? Yes No

ECU Presbyterian Campus Ministry

A place to: believe, belong, and become...

Please fill out this application, in its entirety, for the Spring Break 2011 Mission Trip.