Short Term Trips Application “And the things that thou hast heard of me among many witnesses, the same commit thou to faithful men, who shall be able to teach others also” - 2 Timothy 2:2 Full Name Preferred Name (optional) Are you male or female? Male Female What is your shirt size? Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone NumberEmail Address Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age Country of Birth Marital Status Single Engaged Married Separated Divorced Widowed Spouse's Name Do you have a current passport with an expiration date that is more than six months beyond the trip dates?If you do not have a current passport, it is very important you apply as soon as possible at the Post Office, and notify HHI as soon as you have received your passport. Name as it Appears on Passport Expiration Date Passport Number Emergency Contact Name Relationship to You Contact's Phone Number Present State of Health Excellent Good Average Poor Are you under any medical restrictions or do you have any medical issues that would affect your participation in this trip?If yes, please explainList all medications (prescribed or over-the-counter) that you are taking:List Any Allergies You May Have Where is your church membership? Do you attend your home church regularly? Yes No If not, where are you attending regularly? Pastor's Name Is your church prayerfully supporting you in this trip? List present ministry involvement: Please provide names, phone numbers and email addresses for two (2) people we may contact to give a reference for you: How long have you been a believer? What do you expect the Lord to accomplish in and through you on this short-term trip?What special gifts and abilities do you have that you desire to use on this trip? (preaching, teaching, music, youth, construction, medical, drama, puppets, sports, etc.)
