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A10 2020 Vietnam Application
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GENERAL INFORMATION
Legal First Name
Your answer
Legal Last Name
Your answer
Birth Date
MM
/
DD
/
YYYY
Age
Your answer
Email Address
Your answer
Phone Number
Your answer
Address
Your answer
Place of Birth
Your answer
Are you a legal US Citizen?
Yes
No
Clear selection
AREA 10 INVOLVEMENT
Do you attend Area 10's weekend services?
Yes
No
Clear selection
Do you serve in a ministry at Area 10?
Yes
No
Clear selection
Which ministries have you served or are currently serving in?
Your answer
Do you attend an Area 10 small group?
Yes
No
Clear selection
If so, who is your small group leader?
Your answer
Are you an Area 10 partner?
Yes
No
Clear selection
YOUR FAITH JOURNEY
When and how did you become a Christian?
Your answer
Describe your personal relationship with Jesus.
Your answer
When were you baptized?
Your answer
What previous mission trip experience have you had?
Your answer
What were some of the lessons learned on your previous mission trip experience(s)?
Your answer
2019 VIETNAM TRIP
Friday, May 29 - Sunday, June 7
Why would you like to participate in this trip?
Your answer
What would make this mission trip a success for you?
Your answer
What hesitations or fears do you have regarding a missions trip to Vietnam?
Your answer
GIFTS AND SKILLS
In what languages are you fluent (other than English)?
Your answer
What, if any, musical instruments do you play?
Your answer
Do you have any experience and proficiency in any of the below areas? Please check all that apply.
Singing
Dancing
Juggling
Clowning
Teaching
Crafting
other
Please describe any pertinent skills or certifications you think might be useful for this trip.
Your answer
Self Assessment
Please rate the following questions on a scale of 1 -5. 1 being the lowest and 5 being the highest.
Rate yourself on your ability to teach or preach.
1
2
3
4
5
Clear selection
Rate yourself on your ability to lead.
1
2
3
4
5
Clear selection
Rate yourself on your ability to take direction.
1
2
3
4
5
Clear selection
Rate yourself on your ability to be flexible.
1
2
3
4
5
Clear selection
Rate yourself on your ability to be patient.
1
2
3
4
5
Clear selection
Rate yourself on your ability to communicate your thoughts and feelings with others.
1
2
3
4
5
Clear selection
MEDICAL BACKGROUND AND INFORMATION
Do you have medical insurance?
Yes
No
Clear selection
Please list any food and medicine allergies.
Your answer
Are you currently receiving any counseling, therapy, or prescribed medications for mental health purposes? If answer is yes, we will follow up during the interview process.
Yes
No
Clear selection
Do you have any physical health limitations that may impact your ability to travel, or participate in all planned group activities? If answer is yes, we will follow up during the interview process.
Yes
No
Clear selection
Please list any medications (prescription or over the counter) you take on a regular basis.
Your answer
REFERENCES
Please list 2 references that can speak to your character and personality.
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Email address
Your answer
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Email address
Your answer
EMERGENCY CONTACT
Name
Your answer
Relationship
Your answer
Phone number
Your answer
Email address
Your answer
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