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Missions Application

If you woud like to print a PDF version of the application please click the logo on the left.

*** Please fill out the attached "CHILD PERMISSION FORM" (link on the left) if the FATHER only will be bringing a child across the border. The MOTHER must sign the permission form and have it notarized.

           Mission Information

Village/Site: 
Starting Date:  
   
           General Information
Prefix: 
Name: 
Address: 
City, State: 
Zip: 
Country: 
Telephone: 
Mobile Telephone: 
E-Mail: 
 

           Personal Information

Gender: 
Male Female
Occupation: 
Marital Status: 
Single Married
Spouse Name: 
T-Shirt Size: 
M L XL XXL XXXL
   

           Travel Information

Departing Airport:
Citizenship:
Date of Issuance:
(Passport)
Date of Expiration:
(Passport)
Date of Birth:
Place of Birth:
   

           Field of Ministry

Previous CHIA Mission:
Location: Date:
Are you a Pastor or Preacher?  Yes No
Are you willing to do a Devotional: Yes No
Foreign languages:
Proficiency: 
Excellent Good Fair Cloudy
Do you sing?: 
Yes No
  If yes, would you on this Mission Yes No
Special Skills (Balloons, Guitar, etc.) 
   

           Medical/Emergency Information

Any health problems?
Yes No
If Yes, please describe:
Current Medication(s): 
Diseases/Allergies: 
Sleeping Conditions: 
(snoring, insomnia, etc) 
Emergency Contact #1 (not traveling with you)
Prefix: 
Name: 
Address: 
City, State: 
Zip: 
Country: 
Telephone: 
Mobile Telephone: 
Emergency Contact #2 (not traveling with you)
Prefix: 
Name: 
Address: 
City, State: 
Zip: 
Country: 
Telephone: 
Mobile Telephone: 
   

           Ministry Information

Home Church : 
Pastor:
Address: 
City, State: 
Zip: 
Country: 
Telephone: 
 
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