* FULL Name as it appears on PASSPORT
* Marital Status Select one Single Married Divorced Separated Widowed Unknown
* EMERGENCY CONTACT (List name and #. List allergies or medical condition we should be aware of)
* Are you currently under the care of a physician Select one yes no
* Health Insurance Provider (Please provide your ID#, Group#, Name of Policy Holder, Employer, and Name of Beneficiary.)
* Reference (List 1 person not related to you that you have known for at least 1 year. Provide the person's name, phone #, relationship, & years acquainted)
* Having understood the description of work on this project, please describe the work that you hope to participate in with this team.
* Please indicate any special skills, talents or Christian service experience that you feel may be helpful to this ministry:
* Church Membership Select one Central Baptist Church Other
* Please list the ministries with which you have been involved outside of your church. (Please include time of involvement and any leadership positions held.)
* Are you willing to be involved in the outreach programs of CBC before and after this mission project? Select one Yes No
* Please write, in your own words, how a person can become saved:
* Please write your own salvation story including when you were baptized:
* How are you growing in your relationship with Christ? (emphasizing your prayer life and Bible study/quiet time):
* Give a brief explanation of how you know it is God's will for you to go on this mission project?
* Excluding minor traffic violations, have you ever been convicted of any violations of any law or ordinance? Select one Yes No
* Do you have a daily prayer and Bible study time? Select one Yes No
* Are you living a lifestyle of pre-marital, extra-marital or homosexual relationships? Select one Yes No
* Do you completely abstain from the use of alcohol, illegal drugs, or tobacco products? Select one Yes No
* Do you have any physical impairments that prevent you from doing physical work on the mission field? Select one Yes No