Saints Equipped to Evangelize

Short Term Application

To be used for ministry teams, work teams, Cooks Assistant and Handyman opportunities

To complete this application you will need:

A current digital photo of yourself
A letter expressing your personal testimony
A letter of recommendation from your Pastor.

DESIRED DATES

Date of arrival in Italy:

Month *

Day *

Year *

Date of departure from Italy:

Month *

Day *

Year *

PERSONAL INFORMATION

Full Name as it appears on passport:

LAST *

FIRST *

MIDDLE *

Nick Name, if any

Address

Street Address

Address continued

City

State

Zip

Cell Phone #: *

*( )

* -

Home Phone #: *

*( )

* -

Work Phone #:

( )

E Mail Address *

Passport Number *

Birth Date *

Place of Birth *

Sex * MaleFemale

Height *

Weight *

Marital status *

If Other, please explain below.

T-Shirt Size *

PRIMARY EMERGENCY CONTACT INFORMATION

Relationship (if applicant is a minor, than emergency contact must be parent or legal guardian) *

Full Name: *

Last *

First *

Middle *

Phone #: *

( )

Email address *

Address

Street Address

Address continued

City

State

Zip

SECONDARY EMERGENCY CONTACT INFORMATION

Relationship *

Full Name: *

Last *

First *

Middle *

Phone #: *

( )

Email address *

Address

Street Address

Address continued

City

State

Zip

SENDING CHURCH INFORMATION

Name of your church *

Address

Street Address

Address continued

City

State

Zip

Pastor's Name: *

Last

First

Middle

Phone #: *

( )

Email address *

ADDITIONAL INFORMATION

Please attach a current photo *

Why do you wish to be considered for this team? *

Any special skills/talents? *

Health

Are you in GOOD health * YESNO - explain below

If NO explain here

Do you have ANY food or medicine allergies * NOYES - describe below

If YES explain here

Please list any prescription medications you are currently taking or will be taking.

By checking this box, I certify that the information provided on the application is accurate to the best of my knowledge. * Agreed

A letter of Pastoral recommendation and a personal testimony MUST accompany this application.

This letter from your Pastor and your personal testimony can be either attached to this application or FAXED to us at (941) 795 5814

Attach your digital photo, testimony and Pastor's letter here

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