Background Information

Provide a brief history of your Christian walk.

Describe your ministry involvement in your Home Group.

Are you a member of the Servant Team?
Yes
No

Are you a member of the Fiscal Support Team?
Yes
No

Have you ever gone on a Short-term Mission trip or participated in other mission-related projects before?
Yes
No

If yes, where, when, with whom? What was the goal of that trip?

Have you ever traveled overseas?
Yes
No

Have you had contact with racial, ethnic or cultural groups other than you own in this or another country?
Yes
No

If yes, where, when, with whom?

Do you speak a language other than English?
Yes
No

If yes what language(s)? Degree of fluency?

What do you feel you can contribute in the way of skills or gifting? Please be specific.

Have you taken any type of Missions training seminars, classes etc.? (For example: Perspectives on the World Christian Movement, Courses offered by Xenos, ACMC Conferences)

Have you completed Christian Ministry?
Yes
No

Briefly state why you want to go on this assignment and how you hope to use your cross-cultural experience when you return.

List two people in the church who know you and would serve as references for you (preferably a leader of a home church, cell group or ministry house). Please have these people complete the reference form.

Medical Information

Any major illness during the past year?
Yes
No

If yes, please explain:

Do you take any medication regularly?
Yes
No

If yes, please explain:

Do you have any allergies?
Yes
No

If yes, please explain:

Have you been treated or hospitalized for a mental or emotional condition in the last 5 years?
Yes
No

If yes, please explain.

Have you checked with your health care provider regarding this trip?
Yes
No

Do you have any physical limitations/disabilities that would prevent you from participating in this trip?
Yes
No

If yes, please explain:

Do you have adequate medical insurance?
Yes
No

Who would we contact in case of an emergency?

Additional Information

Please use the space below to provide any additional information you would like to us to know.

I agree to attend the team meetings, training sessions, debriefing and participate in post-trip informational meetings concerning our trip.

I agree to submit to the leadership appointed, to adhere to the policies of XCF and to conduct myself in a manner consistent with biblical standards.

I agree that submitting this form online is equivalent to providing my signature.

Please ensure you have responded to every question above.

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