Application

Today's Date

1) PERSONAL INFORMATION

Church/Team Name *

First Name (as on passport) *

Middle Name (as on passport) *

Last Name (as on passport) *

Goes By Name *

Cell Phone *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Passport Number *

Passport Expiration Date *

Citizenship *

Country of Birth *

Date of Birth *

Gender *

Female
Male
Other

T-Shirt Size *

2) HEALTH INFORMATION

Please answer the following questions to better inform E=H and your Team Leader on your health profile.

Please list any allergies and indicate severity:

Please list dietary restrictions:

Please list any medical conditions we should be aware of:

Please list medications:

Please indicate any additional information that you feel would be of use for E=H.

3) EMERGENCY CONTACT INFORMATION:

Name (First, Last): *

Relationship: *

Email *

Cell Phone: *

Other Phone:

Please type your initials to authorize E=H to contact the above person during an emergency situation. If you are under 18, the parent or guardian should add their initials.

4) CHARACTER INFORMATION

IDENTIFY AND COMMENT ON YOUR THREE MOST PROMINENT STRENGTHS AND WEAKNESSES:

Strengths: (1)

Strengths: (2)

Strengths: (3)

Weaknesses: (1)

Weaknesses: (2)

Weaknesses: (3)

How are you involved in your community?

What specific skills or talents do you have? (i.e. singing, acting, juggling, carpentry, etc.)

Describe why you want to participant in a Hope on the Ground program and what you hope to gain.

If I am selected for a Hope on the Ground Experience, I will make every effort to:
• Submit my personal desires (privacy, food, dress etc) to the standards of the field.
• Willingly obey my leader(s) in all things throughout my Hope on the Ground Experience.
• Build up my fellow team members.
• Participate in pre-field meetings and preparations post-field meetings.

Digital Signature

Date

Parent's Digital Signature (if under 18 years)

Date

Individual Application Form

1) PERSONAL INFORMATION

2) HEALTH INFORMATION

3) EMERGENCY CONTACT INFORMATION:

4) CHARACTER INFORMATION