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INTERmission 2012 – Application

Step 1 of 6

16%

GYC Missions
62 Amory Street
Cambridge MA 02139

Dates: June 3-17, 2012 & August 5-19, 2012
Location: Bunera, Tanzania
Organization: GYC, REACH International, & ALIVE Tanzania
Project: Medical/Dental, Evangelism, Children's Ministries & Community Outreach/Services
Cost: $250 + Personal Airfare

First payment of $100 must accompany your complete application. All prices are in US funds. Checks payable to GYC. Applicants are selected on a first come, first serve basis.

My Stats
Full Legal Name*
FirstLast
Please Enter Address Here*
Street AddressCityState / Province / RegionZip / Postal CodeCountry
Phone*
Email*
Date of Birth*
MM
DD
YYYY
Gender*
- Male
- Female
Passport Number
Country
Expiration Date
MM
DD
YYYY
T-Shirt Size*
- Extra Small
- Small
- Medium
- Large
- Extra Large
Emergency Contact*
Relation*
Emergency Contact's Address*
Street AddressCityState / Province / RegionZip / Postal CodeCountry
Emergency Contact's Phone*

My Trips
Check which mission trip you wish to apply for.
Choose to go on the first, second, or both trips!*
- June 3-17, 2012 > Bunera, Tanzania
- August 5-19, 2012 > Bunera, Tanzania

My Health
Please provide the following information. All areas must complete.
Have you had your Tetanus shot as required?*
- Yes
- No
Date of Last Tetanus Shot*
MM
DD
YYYY
Have you had your Yellow Fever shot as required?*
- Yes
- No
Date of Last Yellow Fever Shot*
MM
DD
YYYY
Please note: other vaccinations may be required depending on your country of origin. However, Tetanus and Yellow Fever are required for ALL participants regardless of country of origin.
Illnesses
- Asthma
- Diabetes
- Cancer
- Colitis
- Ulcers
- Bleeding Tendency
- High Blood Pressure
- Migraine Headaches
- Epilepsy [Seizures]
- Heart Disorder
Other illnesses or explanation of the above:
Have you used any alcohol, tobacco or recreational drugs in the past two years? If yes, please explain:*
Do you have any current medical conditions that need to be considered? If yes, please explain:*
Do you have any medical conditions that would hinder your work in a certain climate, altitude or living condition? If yes, please explain: *
Medications*
Please list all the current medications you take. Include the name, amount (dose) and how often you take it (frequency).
Allergies*
Please list any allergies you may have.
Dietary*
All meals will be vegetarian. Please list any other dietary needs you may have.

My Life
Please briefly share with us your spiritual journey. What has God done in your life and what is He doing now?*
Have you ever been involved in a mission trip before? If so, where, with whom and when?*
Why are you interested in being involved in this mission trip?*
Do you understand the basic beliefs of the Seventh-Day Adventist Church?*
- Yes
- No
Are you in agreement with them? If not, please explain:*
Local Church*
Church's Phone
Local Pastor*
Pastor's Phone*
Have you ever been convicted of a crime other than a traffic related violation? If yes, please explain:*
What is your educational history? [School, Degree, Graduation Date]*
Have you ever been dismissed from any educational institution? If yes, please explain:*
Do you speak Swahili fluently?*
- Yes
- No
Are you willing to translate?
- Yes
- No
Are you knowledgable in:
- Evangelism
- Medical/Dental
- Children's Ministries
- Community Outreach/Service
If so, please explain:
Would you like to be trained in:
- Evangelism
- Medical/Dental
- Children's Ministries
- Community Outreach/Services
If so, please explain:
What other talents and abilities do you have that you believe may be useful on this mission trip? (Musical, teaching, leadership, language, children, health training, etc.)
Would you be interested in mission opportunities in the United States?
- Yes
- No

Payment
First payment of $100 must accompany your complete application. All prices are in US funds.
Payment Options*
- Down Payment - $100
- Full Payment - $250

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