ࡱ> [ {bjbj *ΐΐ&:@WWWkkk8_<kkG # # # # !*r/p*F,F,F,F,F,F,FIK,FW1!"!11,F# # s%G;;;1^8# W# *F;1*F;;rDT?E# eRبWk@2NJEF;G0kGXE[L3[LE[LWE 11;11111,F,F;111kG1111[L111111111 : PAID Everyday Exports Application Please send to: Vineyard Church C/O Dean Hines(1201 Riverside Ave (Ft. Collins, Co 80524((970)484-5999 Date FORMTEXT       Location of mission trip applying for:  FORMDROPDOWN  Date of trip FORMTEXT        FORMCHECKBOX  Mr.  FORMCHECKBOX  Miss  FORMCHECKBOX  Mrs. Sex:  FORMCHECKBOX  Male  FORMCHECKBOX  Female This must be your legal name as printed on your Passport/Birth Certificate Name: Last:  FORMTEXT       First: FORMTEXT      Middle: FORMTEXT      Maiden: FORMTEXT       Address: FORMTEXT       City: FORMTEXT       State: FORMTEXT       Zip: FORMTEXT       Home # FORMTEXT       Work # FORMTEXT       Cell # FORMTEXT       Fax: FORMTEXT       Email: FORMTEXT       Passport #  FORMTEXT       or, I will apply for a passport on:  FORMTEXT       PERSONAL: Marital Status:  FORMCHECKBOX  Single  FORMCHECKBOX  Married  FORMCHECKBOX Separated  FORMCHECKBOX  Divorced  FORMCHECKBOX Widowed Birth date: FORMTEXT       Age:  FORMTEXT       Birthplace: City: FORMTEXT       State/province or country: FORMTEXT       Are you a citizen of the U.S.?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If no, country of citizenship:  FORMTEXT       Are you a resident alien?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please include a copy of U.S. government authorization SPIRITUAL/CHURCH/MISSIONS: When did you accept Jesus Christ as your personal Savior?  FORMTEXT       Do you attend church regularly?  FORMCHECKBOX Yes  FORMCHECKBOX No Are you a member of a church?  FORMCHECKBOX  Yes  FORMCHECKBOX  No What volunteer work or ministry are you currently involved with, or have done (please list dates) here at Vineyard?  FORMTEXT       What other type of volunteer work or ministry you have done?  FORMTEXT       Home Church/ denomination:  FORMTEXT       Pastor s name: FORMTEXT       Phone ( FORMTEXT    )  FORMTEXT       Address of church:  FORMTEXT       City: FORMTEXT       State: FORMTEXT       Zip:  FORMTEXT       What steps are you taking or have you taken to grow spiritually and to prepare yourself for the mission field?  FORMTEXT       Have you served on any previous mission trips?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, briefly describe location, date and organization leading trip. Have you ever been involved in the occult?  FORMCHECKBOX  Yes  FORMCHECKBOX  No If yes, please explain FORMTEXT       Briefly describe how you became a Christian. FORMTEXT       FAMILY: If married, name of spouse: FORMTEXT        FORMCHECKBOX  husband  FORMCHECKBOX wife Does your spouse agree with you going on a mission trip?  FORMCHECKBOX Yes  FORMCHECKBOX  No Name of your father or guardian (if applicable)  FORMTEXT       Address:  FORMTEXT       City: FORMTEXT       State: FORMTEXT       Zip: FORMTEXT       Phone ( FORMTEXT    )  FORMTEXT       Occupation: FORMTEXT       Name of your mother or guardian (if applicable)  FORMTEXT       Address: City: FORMTEXT       State: FORMTEXT       Zip:  FORMTEXT       Phone ( FORMTEXT    )  FORMTEXT       Occupation_____________________ EDUCATION & PREPARATION: What is the highest level of education completed?  FORMTEXT       What is your current occupation?  FORMTEXT       Are you currently attending school?  FORMCHECKBOX Yes  FORMCHECKBOX No Where?  FORMTEXT       When do you expect to graduate?  FORMTEXT       With what degree?  FORMTEXT       TRAINING: What other educational experiences have you had (such as special training, music lessons, travel, etc.)?  FORMTEXT       Please list any mission courses you have taken:  FORMTEXT       Please list mission-related books and periodicals you have read:  FORMTEXT       What non-English languages have you studied and for how long?  FORMTEXT       In which non-English languages are you able to converse?  FORMTEXT       EMPLOYMENT EXPERIENCE: Present employer  FORMTEXT       Duties performed  FORMTEXT       HISTORY: Please answer the following questions as accurately as possible. A yes or no to any of these questions will not automatically cause someone to be disqualified on the trip. However, we will discuss these topics with you. In the last year, have you used, or, are you currently using illegal drugs?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, date of last use:  FORMTEXT       If yes, please explain:  FORMTEXT       Are you currently living with someone of the opposite sex with whom you are not married?  FORMCHECKBOX Yes  FORMCHECKBOX No If so please explain  FORMTEXT       Sexually, are you currently living a life style consistent with Biblical principals? (Not involved in: sexual activities with someone other than your spouse, homosexuality, or other inappropriate activities.)  FORMCHECKBOX Yes  FORMCHECKBOX No Have there been any exceptions in the last year?  FORMCHECKBOX Yes  FORMCHECKBOX No Do you currently smoke?  FORMCHECKBOX Yes  FORMCHECKBOX No Do you drink alcoholic beverages?  FORMCHECKBOX Yes  FORMCHECKBOX No Have you ever been arrested?  FORMCHECKBOX Y BDF " 6 8 : D F    & ( D F H Z \ ֽ𨢕tijhlLUj.hlLU hlLCJjhlLCJUmHnHujhlLCJU hlLCJjhlLCJUjthlLUjhlLUmHnHujhlLUjhlLU jhlL hlLCJ hlL>*hlLhlL>*B*CJph) DFH  n p B D F RT$a$$ & Fa$\ x z |     ( * , 6 8 F H \ ^ ` j l jBhlLUjhlLUjZhlLUjhlLUjhlLUmHnHujrhlLU hlLCJjhlLUjhlLUjhlLUjhlLUhlL3     0 2 4 > @ B D P R f h j t v jx hlLUj hlLUjhlLUjhlLU hlLCJjhlLUj*hlLUjhlLUmHnHujhlLUjhlLUhlL h0wh0w7 468BD\^rtv24PRTln ">@BRTj hlLUj hlLUj8 hlLUj hlLUjP hlLU hlLCJ hlLCJj hlLUjd hlLUjhlLUmHnHuj hlLUhlLjhlLU2TjlRThjlvxz\^rtvjfhlLUjhlLUjzhlLUjhlLUjhlLU hlLCJjhlLUjhlLUmHnHuj hlLUjhlLUhlL5zrt\Z\RX 4D HJ^`blnrtLNjlnz|46Jj"hlLUjhlLUj6hlLUjhlLUjJhlLUjhlLUmHnHujhlLU hlLCJjRhlLUhlLjhlLUjhlLU2JLNXZ\ "$&,.24HJLVXZ\ԾԳԨԝԒj\hlLUjhlLUjphlLUjhlLUjhlLUjhlLUhlL hlLCJjhlLUmHnHujhlLUjhlLU5 "68:DFR02FHJTV  "$&24PRTαح쭢쭗쭌쭁vjhlLUj hlLUjhlLUj4hlLUjhlLUhlLjhlLCJUmHnHujHhlLCJUjhlLCJU hlLCJjhlLUmHnHujhlLUjhlLU* "$&02Dz|z|ѴġĚڏڄynjZhlLUjhlLUjnhlLUjhlLU hlL5\$jhlL5CJU\mHnHujhlL5CJU\jhlL5CJU\hlL5CJ\hlLjhlLUmHnHujhlLUj hlLU' BDXZ\fhjl     " 6 8 : D F L Z \ p Č|jhlLCJUmHnHuj hlLCJUjhlLCJUjhlLUj2hlLUjhlLU hlLCJjhlLUmHnHujFhlLU hlL>*hlLjhlLUjhlLU-jlL n!p!!"""#####$%%&''h(j())4)))p r t z | ! !F!H!\!^!`!j!l!n!p!!!!!!!!!!!!!!!!! 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FORMTEXT       If yes, attach brief explanation Were you convicted?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, please explain. FORMTEXT       HEALTH: Condition of health:  FORMTEXT      Height  FORMTEXT       Weight  FORMTEXT       Traveling in another country may have variable health resources and require greater physical stamina. Considering this, do you have any health needs, conditions or physical limitations?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, please explain:  FORMTEXT       Is there any reason you would not be able to engage in rigorous outdoor activity, primitive living, high altitudes, extreme temperatures, etc.?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, please explain:  FORMTEXT       Have you ever sought counseling (marital, depression or other)?  FORMCHECKBOX Yes  FORMCHECKBOX No. If yes, please describe FORMTEXT       Have you ever received treatment for drug or alcohol dependency?  FORMCHECKBOX Yes  FORMCHECKBOX No Are you under a doctor s care at the present time?  FORMCHECKBOX Yes  FORMCHECKBOX No If yes, briefly describe. FORMTEXT       Has your education/employment been disrupted for any period of time because of a physical problem or nervous disorder?  FORMCHECKBOX Yes  FORMCHECKBOX No OTHER QUESTIONS: Please list the name of a Leader or Pastor who can serve as a reference:  FORMTEXT      Their phone # ( FORMTEXT    )  FORMTEXT       e-mail  FORMTEXT       Please list the name of a friend, roommate, or co-worker who can serve as a reference:  FORMTEXT      Their phone # ( FORMTEXT    )  FORMTEXT       e-mail  FORMTEXT       Have you sensed God s leading to go on this trip?  FORMCHECKBOX Yes  FORMCHECKBOX No How?  FORMTEXT       Why are you interested in this trip?  FORMTEXT       What do you think some of your gifts and talents are? (1 Cor 12, Rom 12, Eph 4 FORMTEXT       What do you envision your role in the team to be?  FORMTEXT       JUST FOR FUN! If you could be any animal what would it be and why? FORMTEXT       If language were not an obstacle, where would you love to live for a year?  FORMTEXT       What is your favorite bumper sticker and why? FORMTEXT       What is the most useless thing you own? FORMTEXT      What is one of your favorite words?  FORMTEXT       Application Process Application and deposit fee must be received by:  FORMTEXT       The deposit is nonrefundable upon acceptance as a trip participant. This is not an extra charge, but is credited toward the trip. If applicant is not accepted for the trip, the deposit will be refunded. Send application and deposit check, payable to The Vineyard, ATTN: Everyday Exports Please thoughtfully and prayerfully consider the following: I agree that if I am accepted as a member of the Vineyard s 2008  Everyday Exports team serving in FORMTEXT      : I am willing to develop and maintain a servant s attitude. I will be a team member. We will be a team and not a group of individuals. I will be flexible, patient and cooperative. Schedules and plans may change during the trip. I will respect the team leaders and their decisions. I will refrain from complaining and whining, and be creative and supportive. I will be a learner and not a teacher. I will attend all pre-trip planning and learning meetings and post-trip functions. I agree to pay the total trip cost including the deposit whether through personal funding, raising support or both. (I understand that I must personally contribute a minimum of 10% of total trip cost, even if I raise more than the total trip cost from outside contributions). This does not include the costs of my passport, cost of any necessary shots, and spending money. If for any reason I should decide to not go on the trip, after the airline ticket is bought, I understand and agree that I will be responsible to pay for the airline ticket and any expenses incurred on my behalf that cannot be recovered. I agree to the above and the information in this application is accurate!  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