Jeremiah's Hope - Ministry Application

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Current Needs

Summer Camp 2005

TEAM MEMBER APPLICATION

Donesk, Ukraine - Gonimova Orphanage - June 2nd to June 19th, 2005 - $2,400 (coordinated by Steve Taliaferro)

Mariupol, Ukraine - Toddler Orphanage - June 17th to July 4th, 2005 - $2,400 (coordinated by Andrew Kelly)

NAME & ADDRESS

Full Name: (As it would appear on your passport)

Home Address:

College Address: (If different from home.)

Day Phone: Evening Phone:

E-Mail:

PERSONAL INFORMATION

Birthdate: Age:

Passport #: Date of Expiration:

EXPERIENCE

Do you have domestic or international missions experience?

If yes, please explain in detail. We would like to know where you went, what you did and for how long you were there. If multiple trips, please list them and give a brief description:

A FEW QUESTIONS

Describe your temperament and work style. What makes it easy/difficult to work with you?

What is your personal goal for this mission trip?

Are you comfortable working in a situation that may be less than ideal, communication boundaries, unsanitary, etc. ?

Please list your personal and ministerial strengths and needs:

SPIRITUAL

How long have you been a Christian?

Please describe your personal walk with the Lord at this time:

PHYSICAL

Do you have any medical conditions for which you are currently receiving treatment?

Do you have any physical limitations?

Are you presently taking any medications?

Are you being treated/have you been treated for psychological/emotional disorders?

EMERGENCY CONTACT

Name: Relationship:

Address:

Day Phone: Evening Phone:

E-Mail:

REFERENCES

Name: E-Mail:

If accepted by the team leaders to serve on a mission outreach, I commit to raising or securing the amount required for the specific team with which I will be serving. I will raise or contribute these funds by the deadlines as laid out by the ministry. I understand that all money donated by me or those I contact is fully released by me and them to become a part of the Jeremiah's Hope ministry fund.

I promise to demonstrate a Christian attitude which will bring glory to God.

By submitting this application, I acknowledge that all information is current and correct.