SWMCF - Short Term Mission Trip Application

PLEASE READ CAREFULLY - This is a FOUR (4) page lengthy application. IT HAS TO BE COMPLETED IN ONE SITTING. There is no way to save the information and complete it later. If you prefer to print this application, fill it out by hand, scan it, and email it back to us... please CLICK HERE.

Today's Date
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Your Name (as it appears on your PASSPORT)(*)
Please let us know your name.

First Name - (please retype your first name)
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Last Name - (please retype your last name)
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Title
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Date of Birth(*)
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Age
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What is your T-shirt size? (S-M-L-XL-XXL)
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Basic Trip Information

Trip Country and City
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Trip Date
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What mission leaders have invited you to pursue this trip?
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Personal Information

Home Address:
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Home City:
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Home State:
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Home Zip:
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Home Phone or Cell(*)
Put your cell or landline contact number.

Day time phone #
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Your Email(*)
Please let us know your email address.

Passport Number:(*)
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Passport Expiration:(*)
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Special Language Skills:
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Nearest Airport:
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Business Information

Business Name:
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Business Address:
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Business City:
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Business State:
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Business Zip:
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Business Phone:
Put your cell or landline contact number.

 

Pastor's Name and Contact Information

Pastor's name
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Pastor's Home Phone or Cell
Put your cell or landline contact number.

Pastor's day time phone #
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Pastor's Email
Please let us know your email address.

Church Affiliation:
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Please write a brief description explaining what you plan to do, what your area of expertise is and briefly describe your past experiences.
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Faith Background

If you are a Christian, describe your Christian experience and what being a Christian means to you.
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What are your views about Jesus Christ and his followers?
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Why are you seeking to serve in a Christian mission setting?
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REFERENCES

Please list the names and titles of two references, other than family members, who will send emails of recommendation. These emails can be sent to rcabe@swmc.org. Please touch base with your references and ask them to provide the needed email.
Name, Address, and Title of Reference 1
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Reference 1 - email address
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Name, Address, and Title of Reference 2
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Reference 2 - Email Address
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Emergency Contact Information

VOI requires and secures emergency evacuation coverage for each trip participant. The following information will assist us in securing the proper coverage.
Name of Contact Person:(*)
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Phone # 1(*)
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Phone # 2
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Address of Contact Person
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Name of Contact Person # 2:
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Contact # 2 - Phone # 1
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Contact # 2 - Phone # 2
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Address of Contact Person # 2
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Name of Beneficiary for Traverl's Insurance:
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Relationship to you:
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Health Information

Health Condition:
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If marked FAIR or POOR, please explain.
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List all medications, allergies, and your reactions to them:
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List all pertinent health information and dietary needs:
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Have you had all appropriate immunizations recommended by the CDC for specified travel area?
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(Please see the CDC website at www.cdc.gov and view the Traveler's Health section for health information about the region you will be traveling in. You are responsible for obtaining CDC recommended immunizations prior to your departure.)
Date of last TB test:
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Results of last TB test
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Southwestern Medical Clinic (SWMC) Missionary


Team Member Code of Conduct


It is a privilege and honor to serve the Lord and the people He cares so deeply about around the world. SWMC has high expectations for what God will do in us and through us during each mission trip. As a team member, you are volunteering to be the hands and feet of Jesus, touching a world in need. We believe that God uses our mission trips to bless those we encounter and give team members an opportunity to grow in their own faith and view the character of God from a fresh perspective.


On all our trips, we look to God's Word to lead us, especially verses like Matthew 5:16 which says: "In the same way, let your light shine before others, so that they may see your good works and give glory to your Father who is in heaven."


Before, during, and after the mission trip, we are representing our Lord Jesus Christ as well as SWMC and our partner organizations and missionaries. Therefore, we have an expectation that team members will conduct themselves with the highest standards of integrity and in a way that is consistent with Christian love and respect. This conduct includes how we dress, how we speak, how we interact with our own team members, and how we interact with those we encounter and serve on the mission field. Our conduct is an important part of our testimony and reputation as an organization.


Team members must strive in every way, with reliance upon the Holy Spirit, to maintain an attitude and behavior that is Christ-like. The guidelines that follow are not only to assure that our team is effective in our mission, but are designed to keep all team members safe and to foster a positive learning and worship experience for all of us. In signing below, I accept the following conditions and I agree to:


1. Embrace a servant attitude. In dealing with my fellow team members and also those we encounter on our trip, I will honor and treat everyone with love and respect. I will have a willingness to work through conflict and disputes that may arise. I will work with a kind and humble attitude and be willing to ask for help. I will also be willing to help others when they are in need. I will not be critical of the host country or missionaries, remembering that I am there to support and encourage an established ministry. I will make an effort to understand the host culture and remember that my way is not always the best way. I will strive to be flexible and adjust my personal desires for the sake of ministry.


2. Make sure that my outward appearance and language reflect the character of Christ. I will be sensitive to cultural expectations for Christian dress and dress modestly at all times in the host country, understanding that it may require me to be uncomfortable. I will avoid profanity, insensitive humor, derogatory comments, and arguments about politics, religion, and race. I understand that inappropriate comments could undermine team cohesion or jeopardize our ministry's effectiveness.


3. Be sensitive to others by modifying my use of tobacco or alcoholic beverages while in the host country. Each host culture will have different attitude regarding these behaviors and I will seek guidance from my host or team leader if expectations are not clear. I will refrain from criminal activities including use of illegal drugs, vandalism, or stealing.


4. Understand that I am part of a team. I will participate in team meetings and meet deadlines as they are requested. I will foster an environment of team bonding by limiting my use of headphones and cell phones during team gatherings and come ready to participate in devotional and worship times. I will reach out to all members of my team, not just those I knew before the trip. I will work diligently in whatever tasks are assigned to me. I will respect the team leaders and their decisions, and I understand that all concerns should be addressed with them promptly.


5. Recognize that the host culture will look to me as an example of integrity. I will avoid any actions which might be perceived as amorous toward those I encounter during the trip. I will be careful in all conversations or social contacts with team members, missionaries, and nationals and refrain from intentionally seeking romantic relationships. I will also respect the host culture by seeking guidance from missionaries/local hosts regarding appropriate shopping/bargaining practices and gift-giving. I will not venture out alone but only with a group and with proper permission..


6. Understand that repeated and willful neglect of the above statements may result in my being asked to return home immediately at my own expense. By signing below, you are stating that you agree and will abide by the SWMC Team Member Code of Conduct during the mission trip dates and at all Pre & Post trip meeting and interactions.


By checking "YES, I agree" below, You hereby attest that the information provided above is true and you are the individual whose name appears on the first line (NAME) of this form.

Furthermore, by clicking "YES, I agree" below you agree to abide by the code of conduct and you agree to release Southwestern Medical Clinic and Clinic Foundation (SWMC & SWMCF) of all liability pertaining to your involvement in the above mentioned mission trip. You have agreed to participate in this trip voluntarily and understand the risks involved in this type of work and international travel.

If you agree with these statement, please click, "Yes, I agree"
(*)
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Other Information or questions?
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