Trip application

Team Member Application (Group or Church)

The completion of the form below will enable Healing Nations to consider you for short-term ministry in a Christian mission setting.

All information entered is confidential and will only be shared with appropriate personnel.
Before beginning, you will need the names and email addresses of two references.
Also, be prepared to upload a color copy of 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 it to upload during this trip application process.

THIS IS NOT THE MEDICAL TEAM MEMBER APPLICATION. PLEASE VISIT
HEALINGNATIONS.NET/MEDICAL-APPLICATION TO APPLY FOR A MEDICAL TEAM.

"(Required)" indicates required fields

Step 1 of 4

General Information

Which team are you applying for?(Required)

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

First Middle Last

Nickname (if applicable)

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Gender(Required)

Occupation(Required)

Employer(Required)

List your personal strengths and skills useful for this project/trip:(Required)

List your weaknesses:(Required)

List some personal goals you would like to accomplish by participating in this project/trip:(Required)

List church affiliation (if any) and describe your involvement:

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?(Required)

Yes

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

Emergency Contact #1(Required)

First Name Last Name

Relationship(Required)

Phone(Required)

Emergency Contact #2(Required)

First Name Last Name

Relationship(Required)

Phone(Required)

References

Please list two references and let them know they will be receiving an e-mail from Healing Nations with a link to our reference forms. Your application is not considered complete until your references have completed their forms.

Friend/Peer Reference(Required)

First Name Last Name

Friend/Peer Email(Required)

Enter Email Confirm Email

Spiritual Leader or Recent Employer Reference(Required)

First Name Last Name

Spiritual Leader or Recent Employer Email(Required)

Enter Email Confirm Email

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.

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