Staff Travel Form

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STAFF TRAVEL FORM

Staff Travel FormDana.snyder2024-03-27T09:23:11-06:00

Staff Member and Family Travel Form

The completion of the form below will enable Healing Nations to book your travel for staff travel.

All information entered is confidential and will only be shared with appropriate personnel.
Be prepared to upload a color copy of your current medical license as well as your passport picture page (Any app such as CamScanner can capture the image on your phone and email it to you. Once you save the picture to your computer, you are ready to upload).
If you do not have a passport, or need to renew it, visit the State Department website by clicking here. Fill out the appropriate form, make a copy, and scan to upload during this trip application process.

THIS IS NOT THE APPLICATION FOR GROUP OR CHURCH TEAM TRAVEL.

"(Required)" indicates required fields

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Staff Travel Form

Please fill out this form if you are a staff member or a family member of a staff member traveling for non-team travel.

Purpose of Travel(Required)

Assessment country:(Required)

Name (as it appears on your passport)(Required)

First Middle Last

Date of Birth(Required)

Month

Day

Year

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Gender(Required)

Where will you be traveling from?(Required)

Where will you be traveling to?(Required)

Will you need to return to a different city than your departure city?(Required)

Yes

If yes, please list the city you need to return to:

Date of departure(Required)

MM slash DD slash YYYY

Date of return(Required)

MM slash DD slash YYYY

Have you ever been arrested or charged with any criminal offense in any country?(Required)

Yes

You will receive an e-mail from Clear Investigative Advantage Research (CIAResearch) requesting permission for a mandatory background check.

If yes, please explain:(Required)

Emergency Contact and Medical Information

As standard procedure, we require the following information from everyone participating on a trip with Healing Nations. This information will be kept confidential.

Do you have any medical conditions that you are currently being treated for? Do you take any prescription medications for any reason?(Required)

Yes

Please list any conditions you are being treated for along with medications you currently take:(Required)

(Be sure to bring all allergy and/or prescription medications in their original containers)

Do you have any allergies, including food allergies?(Required)

Yes

Please list allergies and allergy medications you take:(Required)

I understand that while THC & CBD products are widely available in the US, many other countries still consider them illegal substances. I understand that I will not be able to bring any vitamins, herbs, supplements, or medications that contain either THC or CBD with me on this trip(Required)

I agree

Emergency Contact #1(Required)

First Name Last Name

Relationship(Required)

Phone(Required)

Emergency Contact #2(Required)

First Name Last Name

Relationship(Required)

Phone(Required)

Passport

Please upload a color copy of pages 2/3 of your passport. If you have not yet received your passport, please upload a copy of your passport application. If you haven't yet applied for a passport, send your passport application to [email protected] as soon as you've submitted it.

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 250 MB, Max. files: 3.

Project Waiver, Crisis Policy, and Code of Conduct

Please read the document below in its entirety before signing and submitting your application. This form will be printable from the confirmation screen and confirmation e-mail. Please print a copy for your records.(Required)

I agree to the Waiver, Crisis Policy, and Code of Conduct

Signature(Required)

Must be signed by a parent or legal guardian if under the age of 18. By signing above, I declare that all information disclosed in this document is correct to the best of my knowledge. I have read and agree to the Project Waiver/Liability Release, Code of Conduct, and Crisis Policy and am in compliance with all documents and statements therein.

Healing Nations is a subsidiary of Global Missions Group which is a registered 501(c)3 non-profit organization in the United States
All donations are tax deductible as allowed by law

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STAFF TRAVEL FORM

Staff Member and Family Travel Form

Staff Travel Form

Emergency Contact and Medical Information

Project Waiver, Crisis Policy, and Code of Conduct