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Full Name
Phone
Email
Address
City
State
Zip Code
Gender
Male
Female
Are you a member of a church?
Yes
No
Name of parent(s) or guardian(s)
Email of parent(s) or guardian(s)
Denomination
Address of parent(s) or guardian(s)
Phone number of parent(s) or guardian(s)
Name of church you attend
Non-Relative Emergency Contact Name
Relationship of Emergency Contact
Emergency Contact Phone Number
Employment History
Name of most recent employer
Dates Employed
Position
Reason for leaving
Medical History
Do you have a history of mental illness, depression, epilepsy, anxiety or anything that requires regular medical attention?
Yes
No
If yes, please explain.
Name of psychiatrist or doctor consulted
Phone number of psychiatrist or doctor
Address of psychiatrist or doctor
Spiritual Life
Please list ministries in your church and community that you have served in and the length of time that you served.
Greatest Strength?
Explain how you feel the Lord is leading in your life.
Area where you would like to see God make a strength in your life?
What are your gifts and talents?
Have you ever shared the gospel with anyone before? If yes, please tell us about it.
What are you expecting from a Global Year?
Do you have any experience in missions? If yes, please describe being sure to include the year(s) you went, country(ies), length(s) of time, and what you did there.
References
Full name
Email address
Phone
What is your relationship to this person?
Full name
Email address
Phone
What is your relationship to this person?
Pastor/Mentor's Name
Email address
Phone
How long has this person been your pastor/mentor?
Education Experience
What year did you or will you graduate from high school?
Schools/Colleges/Universities
Years of attendance
Year graduated
Degree
Personal Testimony
How did you hear about Global Year?
Why do you want to go on this trip?
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