GLOBAL IMPACT TRIPS

APPLICATION FORM

We are excited that you are applying to serve on a Global Impact Trip.
If you are unable to complete the application in one sitting, please click the “Save and Continue Later” option to receive an email link to your application.

"*" indicates required fields

Step 1 of 10

Personal Information

Name*

First Last

Date of Birth*

Gender*

Address*

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

Marital Status*

How long have you attend Fairfax? (round up)*

Education

High School Name and Year Graduated

College and Year Graduated

Degree/Concentration

Work Experience

Please include most recent employment.

Employer

Position

Duration

Career Field

Travel Experience

Passport Number*

Passport Place of Issue*

Passport Expiration Date*

Have you recently received any vaccinations for travel, and/or have a medical shot record for travel?

Briefly describe any cross-cultural experiences you have had.

Emergency Contact

Name*

Relationship*

Phone Number*

Beneficiary (and relationship) for Insurance Policy*

Personal References

Reference 1: Name*

Reference 1: Phone Number*

Reference 2: Name*

Reference 2: Phone Number*

May we contact these references?*

Yes

Trip of Interest

Which trip are you most interested in?*

Hidden

Do you have a second choice?

How has God prompted you to participate in a Global Impact Trip?*

Do you know your spiritual gifts? If so, please describe below.*

Skills

Are you certified in First Aid or EMT?

First Aid

EMT

If so, when?

Hosting/Food Preparation

Skilled Manual Labor

Trade/Mechanical/Electrical, etc.

Administrative

Business

Grant Writing

Information Technology/Computer Skills

Teaching/Instruction/Public Speaking

Religious Training

Music/Other Arts & Crafts

Heatlhcare

Legal

Scientific

Other

Languages

Fluency Level in Spanish

Fluency Level in French

Other and Fluency Level

Health

Do you have any medical/physical conditions that would cause your doctor to have concerns for travel?*

Yes

If yes, please explain.

Do you have any allergies?*

Yes

If yes, please explain.

Are these treated successfully by a prescribed medication or other practice you can carry with you?