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GO Team Application - Romania 2018
Applications due by January 21st, 2018
Application Process:
1. Read the Trip FAQ sheet as provided by the Trip Leader.
2. Complete Part 1 of the application (below)
3. If you are over age 18, complete Part 2 of the application, which is a background check. You will receive an email with instructions on how to submit your background check info.
4. If all of this is completed on time, the trip leader will contact you within 4-6 weeks of the application deadline to let you know whether you have been accepted.
All information on this form will be kept confidential, with disclosure related only to trip placement (Impact staff, Trip Leaders, Medical and Legal advisers, etc.) or as required by law.
*
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Address Line 1
Address Line 2
*
City
*
State/Province/Region
*
Zip/Postal Code
*
Preferred method of contact:
-- Select --
Email
Phone
*
Date of Birth:
*
Will you be 18 years old or older before the trip?:
-- Select --
Yes
No
*
What school do you attend?:
*
Current Grade in School:
-- Select --
9th
10th
11th
12th
*
Gender:
-- Select --
Male
Female
*
Trip ID#
(see FAQ sheet)
:
:
:
Parent Info
If you are under age 18, please complete this section. If you are over age 18, please skip this section.
Parent #1 Name:
Parent #1 Email:
Parent #1 Primary Phone:
Parent #1 Secondary Phone:
Parent #1 Relationship to You:
Parent #2 Name:
Parent #2 Email:
Parent #2 Primary Phone:
Parent #2 Secondary Phone:
Parent #2 Relationship to You:
Passport Info
If you are applying for a national trip (takes place in the US), skip this section. If you are applying for an
international trip
, please complete this section.
:
Name
exactly
as it appears on your passport:
Passport Number:
Passport Date of Issue:
Passport Expiration Date:
:
Your Interest in the Trip
Below are the dates for the GO Team meetings. Please indicate whether you can attend each meeting. There will be a celebration Show & Tell on a Sunday following the team's return. The date for this is TBD.
*
Sunday, March 4th, 2018 (Student & Parent Meeting):
-- Select --
Yes
No
*
Friday, March 16th - Saturday, March 17th, 2018 (Team Retreat):
-- Select --
Yes
No
*
Sunday, April 29th, 2018:
-- Select --
Yes
No
*
Sunday, May 20th, 2018:
-- Select --
Yes
No
*
Thursday, June 14th, 2018:
-- Select --
Yes
No
*
Thursday, July 5th, 2018 (BBQ & Bonfire):
-- Select --
Yes
No
*
Sunday, July 22nd, 2018 (Packing Party):
-- Select --
Yes
No
:
:
Do you speak any languages other than English? If so, what is your fluency level? (e.g., basic words, conversational, fluent) :
:
Please explain your primary reasons for applying for and desiring to be a part of this GO Team trip:
*
:
Fundraising is a required aspect of going on a GO Team trip. Fundraising is beneficial for team members as it teaches them the importance of relying on God and fellow believers for financial, prayer, and emotional support. Where do you anticipate the funds for this trip to come from? :
*
:
:
Gifts & Skills
If you have taken a spiritual gifts assessment in the past, please indicate your top three spiritual gifts.
:
My spiritual gift::
-- Select --
Administration
Apostleship
Counseling
Craftsmanship
Creative
Communication
Discernment
Encouragement
Evangelism
Faith
Giving
Helps
Hospitality
Intercession
Knowledge
Leadership
Mercy
Prophecy
Shepherding
Teaching
Wisdom
I have not taken a spiritual gifts assessment.
My spiritual gift: 2:
-- Select --
Administration
Apostleship
Counseling
Craftsmanship
Creative
Communication
Discernment
Encouragement
Evangelism
Faith
Giving
Helps
Hospitality
Intercession
Knowledge
Leadership
Mercy
Prophecy
Shepherding
Teaching
Wisdom
I have not taken a spiritual gifts assessment.
My spiritual gift: 3:
-- Select --
Administration
Apostleship
Counseling
Craftsmanship
Creative
Communication
Discernment
Encouragement
Evangelism
Faith
Giving
Helps
Hospitality
Intercession
Knowledge
Leadership
Mercy
Prophecy
Shepherding
Teaching
Wisdom
I have not taken a spiritual gifts assessment.
Skills
(check all that apply)
:
Bookkeeping
:
Childcare
:
Construction
:
Computers
:
Cooking
:
Crafts
:
Medical
:
CPR/First Aid Certified
:
Music
:
Photography/Video
:
Sports
:
Teaching
:
Theater
*
How do you wish to serve on this team?:
:
Spiritual Info
*
Are you a regular attender of Blackhawk Church? :
-- Select --
Yes
No
Which site do you typically attend?:
-- Select --
Brader Way
Downtown
Fitchburg
*
How long have you been attending Blackhawk Church?:
Are you a regular attender of another church? If so, please indicate::
*
Are you involved in a HSM Home Group?:
-- Select --
Yes
No
If yes, who is your home group leader?:
Briefly describe how you came to faith in Jesus Christ and how you are growing in your relationship with Him.:
*
:
:
Ministry Experience
Where are you currently serving in the church?:
*
:
Please describe any previous or current ministry experience that you have serving adults and/or children. :
*
:
Please describe any previous or current experience that you have working/volunteering in community service.:
*
:
*
Have you been on a mission trip before?:
-- Select --
Yes
No
If yes, may we contact the trip leader?:
-- Select --
Yes
No
Leader's Name & Contact Info:
If you have been on a mission trip before, where, when, and for how long was your previous trip? What did you do? :
:
:
Background Info
Information will be kept confidential, with disclosure only related to ministry services, or as required by law.
Do you have any medical conditions (e.g. diabetes, lactose intolerance, asthma, history of heart attack or stroke, etc.)?
*
Please indicate, if applicable:
Do you currently have or have you had in the past any mental health issues (depression, bipolar disorder, generalized anxiety disorder, history of psychiatric treatment or hospitalization, etc.)?:
*
Please indicate, if applicable:
Do you have any physical limitations or conditions that will prevent you from performing certain types of activities?:
*
Please indicate, if applicable:
Do you have a drug, alcohol and/or anger problem? Does anyone who knows you think that you have a drug, alcohol and/or anger problem?:
*
Please indicate, if applicable:
Are there any past or present issues (spiritual, physical, emotional/mental, social), which would hinder your ability to work appropriately with children? :
*
Please indicate, if applicable:
Have you in the past or are you currently struggling with any addictions (alcohol, drug, pornography, etc.)?:
*
Please indicate, if applicable:
Have you ever been accused, charged, or convicted of a criminal offense (felony or misdemeanor) other than a parking violation? :
*
Please indicate, if applicable:
:
References
References are required for consideration for this trip and to meet our Child Protection Policy standards. Please provide complete mailing addresses and email address for three references that have acquired accurate knowledge of your character and meet the following criteria
- known you for more than one year
- at least 18 years old
- not related to you
- not your significant other (e.g., boy/girlfriend, spouse)
- not a Blackhawk staff member
- if possible, have witnessed you interacting with children.
***It is required that one of your references either be your HSM home group leader or a mentor to you.
*
Reference #1 Name:
*
Reference #1 Relationship:
*
Reference #1 Email:
*
Reference #1 Address:
:
*
Reference #2 Name:
*
Reference #2 Relationship:
*
Reference #2 Email:
*
Reference #2 Address:
:
*
Reference #3 Name:
*
Reference #3 Relationship:
*
Reference #3 Email:
*
Reference #3 Address:
Upon submitting this form, you will receive an email about providing background check information.
IF YOU ARE 18 YEARS OR OLDER, YOUR APPLICATION WILL NOT BE CONSIDERED COMPLETE UNTIL YOU HAVE SUBMITTED YOUR BACKGROUND CHECK
via the instructions you will receive via an email.
By signing below I agree that the information provided in this application is true, and I authorize the Church (Blackhawk Evangelical Free Church and/or its representative) to verify the information on this form. I authorize any organizations, institutions, churches or references listed in this application to give the church any information (including opinions) that they may have regarding my character and suitability for participation in this trip. I hereby release any individual, organization, employer, church or reference from any and all liability for any damages that may at any time result to me, my heirs, or family, on account of compliance or any attempt to comply with this authorization. Should my application be accepted I agree to adhere to all policies of Blackhawk Church.
In the interest of safety and security I, the undersigned applicant, authorize Blackhawk Evangelical Free Church to procure background information about me, prior to, and at any time during, my service to the organization. This report may include my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and the state sex offender records. I understand that I am entitled to a complete copy of any background information report of which I am the subject upon my request. Also, I understand that I may receive a written summary of my rights under the Fair Credit Reporting Act. :
*
Signature:
PARENTAL CONSENT
If applicant is 17 years old or younger, please have a parent or legal guardian fill out this section.
Do you support your student serving on this trip?:
Yes
No
Is there anything else that you would like us to know that would help improve your child's experience on the trip? (i.e. child's personality, fears, likes/dislikes, etc.)
:
Parent/Guardian Signature (Typing your name here serves as your signature):
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