Short-Term Missions Team Application | DOVE USA Church Planting & Outreach

Welcome! We are so excited to have you join one of our short-term mission teams. If you have a passport, you will need to get it and upload a photo to the application.

Questions? Email us at Missions@doveusa.org or call us at 717-627-1996.

"*" indicates required fields

Trip Information

Which team are you applying for?*

$100 application fee is required upon submission of this form.

Medical Missions // Kenya

I would like to contribute more than the $100 application fee.

Please add the additional amount here. This will be applied to your account.

Short-Term Team Application Fee - Arizona: Immersive Missions*

Price: $0.00

Short-Term Team Application Fee - Kenya: Empowering Missions*

Price: $0.00

Short-Term Team Application Fee - Kenya: Medical Missions*

Price: $0.00

Short-Term Team Application Fee - Guatemala: Next-Gen Missions*

Price: $0.00

Short-Term Team Application Fee - Germany: Practical Missions*

Price: $0.00

Personal Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Birthday*

Age on trip (use lower age if birthday is during trip)*

Please note that if your 18th birthday occurs during the trip, you will need to apply as a minor.

Previous legal name(s)*

Have you ever gone by another name? This information will be used to conduct a criminal background check.

Parent email address(es)*

Please enter one or more email addresses for your parent(s) so that they are included in all communication regarding this trip.

Full legal name*

This will be used to book your flight (if applicable) or run a criminal background check (if you are 18+ and live in Pennsylvania).

First Middle Last

Sex*

Female

Male

Current Church*

Pastor's Name*

How are you serving or have served in your church?*

Training/Experience

Additional info for training/experience

If you checked "instrument" or "other" in the question above, please enter more information here.

Name of Reference*

Ideally, we would prefer your lead elder to complete your reference. If your pastor does not know you very well, you may ask someone from your church who knows you well, like an elder or your small group leader. Please make sure you have downloaded the packet of additional documents at the top of this page, which includes a reference form. We will not contact your reference for you.

First Last

Agreements

Child abuse clearance document*

Instructions on how to obtain your child abuse clearance certificate will be emailed to you upon submission of this form.

I will obtain a child abuse clearance document from my state and forward to DOVE USA Missions.

Please select to agree.*

I will submit 50% of the total cost of the trip at least four months prior to travel.

Please select to agree.*

I will submit the remaining amount due at least two months prior to departure. (Please note that the final cost of the trip may change, depending on the cost of flights at the time of booking.)

Please select to agree.*

I understand that immunizations are not part of the team cost and that I am responsible for paying these costs, no matter whether the immunizations I receive are recommended or required for entry into the country I am applying to serve in.

Parent signature*

Passport Information

If you do not have a current passport, or your passport expires six months or less after your trip, please apply for a new one now.

Are you a US citizen?*

Yes

Where is your citizenship?

Do you have a passport that expires at least six months after the trip is over?*

Yes

Photo of passport*

Please upload a photo of the information page of your passport that clearly shows your name, photo, passport number, and expiration date.

Accepted file types: jpg, png, pdf, Max. file size: 128 MB.

Please select to agree.*

I will obtain a passport and forward a photo of the information page to missions@doveusa.org as soon as possible.

Medical Information

Name of health insurance carrier

Phone

Name of policy holder

First Last

Policy number

If you have any medical or physical limitations that may affect your participating in any activity, please describe below. Leave blank if none.

Are you able to walk one mile?*

In many places around the world, people walk a more than we do in our everyday life. We want to make sure our applicants know what to expect in terms of physical activity.

Yes, no problem

Yes, with a few breaks

It would be somewhat difficult, but I could manage.

I don't think I could.

Are you able to do activities that require moderate exertion?*

Yes, no problem

Yes, with a few breaks

It would be somewhat difficult, but I could manage.

I don't think I could.

What is your height and weight?*

Check the boxes of any condition that applies to you.*

Description of any of the above conditions, including food allergies or specific dietary restrictions

Do you currently take any medications?*

Yes

Please list the medications and the condition being treated.*

Please select to agree.*

I consent to emergency medical treatment deemed necessary in the unlikely event of an accident. I will pay for any and all expenses incurred should insurance not cover them. I also release DOVE USA Missions, the host ministry and staff from any liability resulting from any accident or illness.

Emergency contact 1*

First Last

Relationship to you*

Best phone number*

Email*

Emergency contact 2*

First Last

Relationship to you*

Best phone number*

Email*

Written expression

We want to get to know you! Please answer the following questions.

Why have you chosen to participate on this team?*

Do you have any training that would be applicable to this team?*

What can you contribute to this team?*

How do you plan to cover the finances of this trip?*

How long have you been a Christian? How is God working in your life now?*

How did you hear about this short-term team?*

Recommendation from a friend

Church announcement

DOVE USA Missions website

Facebook

Instagram

Flyer

Other

After clicking "Submit," you should be redirected to a PayPal payment page. If you are not redirected, your application may have missing information, which will be highlighted in red.

Applicant's signature*

By signing below, I attest that all of the information provided in this application is correct to the best of my knowledge.

Payment Method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Instagram

This field is for validation purposes and should be left unchanged.