REACH 2020 Application

REACH 2020 Application
Applicant Contact Information
Full Name (as it will appear on your passport) *

First Name Middle Name Last Name
Name you go by *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail *
Phone Number *

Area Code Phone Number
Birth Date *

Month Day Year
College or University *
Gender *
Chi Alpha Director *
Emergency Contact Information
Name of Emergency Contact Person *

First Name Last Name
Phone Number *

Area Code Phone Number
Relationship to you (mom, etc) *
Team Member Commitment

As a disciple of Jesus Christ and a member of a Chi Alpha REACH missions team, I commit myself while on this mission trip to follow the example of Jesus in responding to all people:
Check each box to indicate your agreement *

I will put the needs of others before my own. I will walk with the attitude of Jesus under all circumstances. I will be flexible and encouraging when our plans abruptly change. With the exception of medical reasons, I will eat everything set before me and thank the Lord for it. I will not speak negatively of people on our team, our missionaries, or the people I have come to serve. I will respect and submit to the local missionary, my team leader, and all those who are in authority over me. I commit that no complaining word will come from my mouth during our mission trip. I will speak words of life and encouragement. I will live in accordance to the Word of God while preparing for and during this mission trip.
Health Information
Mission team members will be walking frequently and for long distances while overseas. How would you rate your overall physical fitness level? *

Excellent Good Fair Poor
Height *
Weight *
Do you have any physical conditions or disabilities that require special medical attention that we should know about? *
If YES, please describe
Do you have any food allergies? *
If YES, please describe
If you answered YES to either of the above, would this condition or allergies potentially hinder your participation on a missions trip? Please explain.
Ministry Skills
List 3 or more skills, talents, hobbies, giftings, etc that might be helpful on this mission trip. *
REACH Team Member Responsibilities

Select Yes or No for each item
I will send out 100 fundraising letters *
I will facilitate one additional fundraiser (ie chicken dinner sale, car wash, yard sale, 5k) *
I will raise 100% of my budget *
If I do not have my full budget raised by January 5, I will make phone calls to those I sent letters to *
I will do the REACH devotions before the trip *
Campus Pastor Recommendation for REACH application

I have spoken with my campus pastor about my desire to participate in this REACH mission trip. He/she recommends that I apply. (We will follow up with your campus pastor to verify this.)
The above statement is true *
Signature and Payment
By signing here, I indicate that I have completed this form accurately and to the best of my knowledge. (Use your mouse or track pad to trace your signature) *

Clear
You may pay your $125 application fee and deposit with Square below OR mail a check to:

Chi Alpha/PO Box 2052/Fortson, GA 31808

Be sure to include "REACH app fee" & your name with the check. Applications will not be considered complete until payment is received.

If you are paying with Square, when you select "Square", a payment field will appear below.
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REACH Application Fee $ 125.00

Total $ 0.00

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Credit Card Number	Security Code
Expiration Date	Postal Code

Comments or Questions
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Applicant Contact Information

Emergency Contact Information

Team Member Commitment

Health Information

Ministry Skills

REACH Team Member Responsibilities

Campus Pastor Recommendation for REACH application

Signature and Payment