Application for Short-term Missionary Service

	Have you been on a previous mission trip with New Life Advance International?  Yes  No If yes, where?/ Dates?
	About Me
	First Name:			Last Name:
	SSN:			E-mail Address:
	Permanent Address
	Street Address:			City:
	State:			Zip:
	Phone:
	Present Address (if different)
	Street Address:			City:
	State:			Zip:
	Phone:
	Age:			Birthdate:
	Weight:			Height:
	Passport No.:			Place & date of issue:
	Country Issued by:
	Languages you speak:
	About My Church
	Home Church:			Pastor's Name:
	Street Address:			City:
	State:			Zip:
	Phone:
	About My Occupation Present Occupation:
	Employer:			Supervisor:
	Address:			City:
	State:			Zip:
	Phone:
	About My Health
	Allergic to any medication/chemical? No Yes       If yes, please explain: Under physician's care at present? No Yes   Taking medications? No Yes What?   Do you use tobacco products? No Yes If yes, are you will to refrain from the use of any of these substances for the duration of this trip? No Yes Do you drink alcohol? No Yes Do you use narcotic drugs? No Yes
	In Case of Emergency, please contact
	Name:			Relationship:
	Street Address:			City:
	State:			Zip:
	Phone:
	Your Physician:			Physician's Address:
	Physician Phone:
	Insurance Company:			Policy Number:
	About My Trip
	Dates of trip which you are applying for:
	Type of Team:	Choose One Evangelism Team Medical Team Construction Team		Country:
	Have you ever been overseas before?	Yes  No		If yes, please explain:
	Have you ever been on a short-term missions trip before?	If yes, please list countries and organizations:
	Dates of your last immunizations (if any):
	Tetanus:			Typhoid:
	Hepatitis A:
	Medical Personnel Only Complete
	Specialty:			Choose one:	Choose One M.D. R.N. LV.N
	Construction Personnel Only Complete
	Construction skill you are most qualified for:
	Experience Level:	Choose One Apprentice or helper Journeyman Master/Supervisor		Other skills and talents: (i.e. teaching ministry, construction)
	Personal Testimony
	If you have gone on a short-term missions trip with NLAI, and have your testimony on file, please check here and only answer question 4. If you have not yet made a commitment to Christ, you need only answer questions 3 & 4.
	1. Describe your     conversion     experience.
	2. Describe your     understanding of     the work of the     Holy Spirit.
	3. Describe your     current relationship     with God.
	4. Describe what you     feel your purpose     for this mission trip     is to be.

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