SWMC-Missionary Forms

Mission Participation Forms

Mission Reimbursement Form (click Here) - FOR SWMC DOCTORS ONLY

First Time Mission Participant Form (click here) - For NON-SWMC associates

SWMC Mission Participant Form (click here)

Mission Funding Request Form (click here)

Code of Conduct - PDF (click here

Long-Term Missionary Re-entry Form (click here



Mission Reimbursement Form

As a Southwestern Medical Clinic doctor, you dedicate a portion of your income to support missions and missionary efforts. As a result, the SMWC Physician's Mission and Ministry Fund reimburses each SWMC missionary doctor with a $1000 reimbursement per each week for the time they participate in short-term foreign missions. This reimbursement is ONLY for full-time SWMC participating doctors.


First Time Mission Participant Form

As a first time SWMC mission participant there are certain things that we want to know about you and certain things we want you to know about us. This form is for anyone who is outside the SWMC family and want to participate in a mission endeavor with us. It is a two (2) part form. The first section is a set of question to help us get to know you better.


This information will be submitted to a review board and someone will be contact you about the next steps. Once you completed this first part (Part 1) and click the send button, you will be email some information along with an IMPORTANT LINK TO (PART 2) of this form. Please save this email. Once you have been approved to participate, you can refer back to your email and follow the link to the next section of the application. Having this link will prevent you from submitting duplicate information. If you do not have the link, you will have to start all over again. For question regarding this form please email. (jkubsch@lakelandhealth.org)


SWMC Mission Participation Form

This form is for those participating in a SWMC Sponsored Mission Trip. It is for SWMC associates and those who have been on previous SWMC Mission endeavors. If you are not an SWMC associate and this is you FIRST mission endeavor with SWMC, please complet the "FIRST TIME" Mission Participant Form.


Mission Funding Request Form

If you have a FUNDING request for a "CHRISTIAN MEDICAL MISSION endeavor, please use this form to submit your request. Anyone can use this form to submit a funding request. However we favor the following charateristics which will be given priority.


  • A Christian - Medical - Mission endeavor>
  • A location that teaches Christian principles.
  • International Medical Mission Work 
  • Family and friends of SWMC associates
  • Projects that are sustainable
  • Projects with build-in accountability


If you are a medical student or resident, PLEASE DO NOT FILL OUT THIS FORM. There is a different section of this website that explains the process for a medical mission scholarships. Please click on this link (Scholarships) or return to the front page and look under Missionary Scholarships.


Code of Conduct PDF

In order to participate in an SWMC Mission endeavor, we ask all participants to agree to a Code of Conduct. If you will like to see what we expect on our mission trip, please click on the link above..


Long-Term Missionary Re-entry Form

As a Long-Term SWMC Missionary, we want to assist you as you return to the states. We would like to know some of the details of your return like: the dates; where you will work; where you will lodge; special needs you may have; etc. Filling out this form will help us help you when you return.