SMI app

Applying as a: *

Student Provider Servant (non-student, non-provider)

Mailing Address: *

Line 1

Line 2

City

State

Zip Code

Country

Do you give your permission to be added to (or remain on) MCO Charleston's email list in order to stay informed on details of this trip? *

Yes No

Upon acceptance you (or someone on your behalf) will be required to pay a non-refundable deposit of $100 to secure your place on the trip. Are you willing and able to do so? *

Yes No

Your Emergency Contact (name - relationship - email address - phone number - mailing address): *

Feel free to add any clarification, questions, or comments about any of the above. *

HEALTH INFORMATION
(We know this is very personal information. MCO will keep all applications confidential within the MCO staff team.)

Have you ever or are you currently being treated for any of the follow (please list all that apply): fainting, heart problems, diabetes, psychosis/ schizophrenia, eating disorder, respiratory problems, seizure/ neurological disorder, any other medical concerns? *

Yes No

Do you have any condition (please list any or all that apply) that could affect your ability to fully function on this trip (i.e. fear of flying, depression, psychiatric treatment, anxiety, sleeping disorder, etc.)? *

Yes No

Please list any prescription medications that you are currently on as well as hospitalization history or major surgeries. *

Please elaborate on any questions above that you answered "yes" to: *

Are you willing to observe culturally sensitive dress codes, attitudes and actions during the trip? *

Yes No

This is a team trip where complete team attendance is expected for the sake of team unity. Attendance of scheduled activities on the trip will be required by all team members. Are you willing to attend all team meetings and scheduled activities while on the trip (i.e. Bible studies, group singing/worship times, etc.)? *

Yes No

Do you consider yourself to be a Christian (this is in no way a requirement in order to be on the team)? What is your understanding of what it means to be a Christian and what is your brief personal spiritual story? *

Check any boxes that you would be excited and willing to help with, if needed, while on the trip: *

Leading the group in singing Playing guitar during group singing Leading a small group discussion of the Bible study Manual labor (whether setting up clinic or other)

Please tell 3-5 things about yourself that make you who you are. These can be experiences (good or bad) that have shaped who you are, skills you have, personal hobbies or interests of yours, etc. There are no rules to this, just let us know a little more about who you are. *

Feel free to add any clarification, questions, or comments about any of the above. *

Signature (please type your name below as your signature that all above information is accurate and true): *

SMI 2018 Nicaragua​Application

SMI 2018 Nicaragua
Application