Application For H2H International

Requested Trip Date?

How did you first hear about H2H?

Full Name:

Address Line 1:

Address Line 2:

City:

State:

Postal Code:

E-Mail Address:

Area code & Telephone (Home):

Area code & Telephone (Worl/School):

Last 4 digits of your SSN#:

Sex:

Date of Birth:

Place of Birth:

Passport #:

Driver's License #:

In the event of an emergency contact:

Name:

Street:

City:
State: Zip:

Area code & Telephone:

Maritial Status:

Spouse Name:

Name of Children

Birth Date

Current Dependent?

Name of Church you presently attend:

Pastor's Name:

Church Address:

Church Telephone Number:

City

State:

Postal Code:

How long have you attended this chuch?

Please list Christian service you have been involved with, and include name of church/organization, your
position, and briefly how you were involved.

Please list your educational background, beginning with High School. Include any college, trade school, or
Bible schools.

Present School Attending or Place of Employment:

If attending school, when will you complete your program?

Have you served in the military?

Date of Discharge:

Have you ever been arrested, fined, jailed or in prision?

Explain:

Are you involved in any current or pending law suits or legal proceedings?

Explain:

Please list and breifly describe any Bible study courses you have taken in the past three years.

Evaluating your education, training skills, experiences, along with the gifts God has given you, in what areas
do you feel you can best serve?

What is your native language?

If you speak more than one language, please list on the space below and indicate your proficiency in that
language.

Have you ever traveled abroad?

If yes, to what country?

Please rate your ability in the following areas on a scale of 1 to 10, with 10 being excellent.

Auto Mechanics

Bookkeeping

Bus driver w/ required license

Cooking

Nursing/EMT

Computer

Operating Sound or Visual Equipment

Preaching

Puppets

Teaching

Singing

Playing a Musical instrument (List):

Other (List):

Would you like to assist with worship music during orientation ad debriefing? Explain:

Please list your hobbies.

Have you had, or presently have:

Chicken Pox

Measles

Mumps

Polio

Diphtheria

Whooping Cough

Tetanus

Sinusitis

Scarlet Fever

Tuberculosis

Pleurisy

Pneumonia

Tonsillitis

Middle Ear Infection

Deafness

Arthritis

Heart Murmurs

Influenza

Peptic Ulcers

Appendicitis

Frequent Colds

Other:

List any physical limitations you have:

Do you wear eyeglasses or contact lenses?

Do you use tobacco, alcohol or narcotic drugs?

Explain:

Do you have any respiratory problems?

Explain:

Do you have any allergies?

What?

Do you suffer from frequent headaches, dizziness, or fainting spells?

Have you ever had a nervous breakdown or been treated for depression?

Explain:

Do you fatigue easily?

Please list serious health concerns that have affected you in the past five years.

Do you have any medical restrictions or handicaps that we might need to make provisions for?

Are you taking any medications?

Explain:

Health Insurance Carrier and Policy Number:

Physician Name and Phone Number (Include area code):

In what ways do you maintain a personal and vital relationship with God?

Why do you believe you are called to minister as a missionary?

Share your personal testimony.