BEFORE filling out this application, be sure to read the scholarship information to make sure you qualify for a scholarship.

The application and all references HAVE TO BE submitted and received at least 90 days in advance of the beginning of the trip.

 

PERSONAL INFORMATION

Street*
 
City* State*
 
Postal Code* Country*
Home Phone* Cell Phone*
*
Gender*
Names of Children

COLLEGE INFORMATION

MEDICAL SCHOOL INFORMATION

RESIDENCY INFORMATION

TRAINING

PASTORAL INFORMATION

Name and address of your church and pastor.

Pastor First Name Pastor Last Name
Street
 
City State
 
Postal Code Country

SPIRITUAL INFORMATION

Please tell us about your relationship with God

PROPOSED MEDICAL MISSIONS WORK

Street
 
City State
 
Postal Code Country
Identify the goals of your proposed mission trip
Identify the specific expenses for your proposed mission trip