Mission DiscoverySend digital Photo

Ecuador

Christmas Break ’16-‘17

APPLICATION FORM

Please fill out. Email to or send to the address, bottom of next page.

Name and Location of Mission Project: Mission Discovery,Ecuador

Date: ~Dec 28, 2016 – Jan 6, 2016Cost: ~$2000 per personfrom Chicago

Orientation to be scheduled in FALL

  1. Personal Information

Name:Age _____ Sex _____ Occupation ______

Phone: (h) ______(c)______(w) ______

E-mail: ______

Mailing Address: ______

Passport Number:______Date of Issue: ___/___/___ Place of issue ______

______I have to get a passport (Go to Post Office for application and Do it soon!)

Conference: ______Bishop:

Local Church and Address:

Church Phone: ______Pastor:

Pastor’s email:

  1. Background Check

Due to the nature of this experience involving both youth and adults, background checks will be used for all participants over 18 yearsof age. Please complete a background check through your conference office to be sent in with your completed application (contact your annual conference office to request an application – your pastor can help!). *If your conference cannot provide a background check, please contact UMVIM-NCJ directly for further instruction.

  1. References

Please give the attached reference form to at least three individuals who can serve as references for your participation in this mission experience. At least one reference should come from your local pastor and the other should be from an individual(s) who know you well and can speak to the information requested.

  1. (Pastor) Name: ______Phone: ______Email: ______
  1. Name: ______Phone: ______Email: ______
  1. Name: ______Phone: ______Email: ______

IV. Application Questionnaire

Please answer the following questions:

  1. Have you ever participated on or led an UMVIM missionexperience? If so list year(s) and project(s)
  1. Please share some about your own Christian journey and what you hope to gain from this experience. Would you be willing to share some of your story with others during our experience together?
  1. Are you willing to commit yourself to leading/co-leading an UMVIM experience locally or internationally within the next three years?
  1. What do you want to learn about UMVIM team leadership during training?
  1. What are your expectations of your team leader(s) and host site coordinator(s) in Ecuador?
  1. The mission will include some fairly rigorous activity and the hours may be long. Please indicate the general state of your health. Is there anything team leaders should be aware of health-wise (allergies, diet, specific medicines that should not be administered, etc.)?
  1. Please check all applicable skills and explain, where appropriate.

___ Language(s) spoken other than English:______

(This is not necessary, but helpful for team leaders to know.)

___ Work with children and youth, including recreational skills, storytelling, art, singing, crafts. Which is best for you? ______

___Building/carpentry skills.

Please indicate your level of expertise: ___Fair ___Good ___Excellent ___Professional

___ Medical services. ___Physician ___Nurse ___First aid training ___CPR training

___ Singing in worship services. ___Solos ___Duets/trios/small groups ___With total group only

___ Playing a musical instrument (specify)______

___ Preaching or giving a prepared talk/devotional

___ Photography. (Explain) ______

___ After Mission Presentations: ___talks ___PPT presentations ___Videos ___News Stories/Articles

___ Other skills/abilities that will contribute to the team experience.)______

To Be Completed By Applicant:

I understand that team members must be flexible, cooperative, and cheerful. I agree to cooperate at all times with the team leader concerning our life together, including daily assignments, food, lodging, and transportation. I agree to stay with the team from beginning to end, to abstain from the use of alcohol and tobacco while on the mission, and to share my faith in an appropriate Christian manner.

______

Applicant’s signatureDate

Application Check List

____Completed and Signed Application Form

____Answers to Application Questionnaire

____Background check

____Reference formgiven to pastor

____

____Reference form given to two other persons

____ Recent Digital photo to

____$100 application fee

RETURNno later thanAugust1, 2016 (earlier is better) to:

Lorna Jost / UMVIM-NCJ

910 4th Street Suite G

Brookings, SD 57006

Enclose a $100.00 per personrefundable down payment.

Make payable to: United Methodist Volunteers In Mission - North Central Jurisdiction (UMVIM-NCJ) designated forMission DiscoveryEcuador - 2016

Only EIGHT spots are available on this team. Space will be filled on a first come first serve basis. Once your application has been reviewed, you will be contacted to verify your acceptance and participation.

United Methodist Volunteers In Mission – North Central Jurisdiction

UMVIM-NCJ

910 4th Street, Suite G

Brookings, SD 57006

Phone: 605/692-3390

Email:

Christian love in action!

REFERENCE REQUEST for MISSION DISCOVERY to Ecuador applicant

______, an applicant to serve on a Mission Discovery Journey to Ecuador for youth and young adults, has given your name as a personal reference. We will greatly appreciate your response to the parts of this questionnaire in which you have knowledge in regard to the applicant. Please return this form to the applicant in a sealed envelope to be included with their application. You may also complete this and send it electronically. Use as much space as necessary. Please put additional comments that you might have at the end of the form.

  1. How long have you known the applicant? How well do you know the applicant?

Where and in what context have you known the applicant? What were/are her/his primary responsibilities?

  1. Do you have personal knowledge, or have you ever heard of the applicant having any problems with any abusive behavior (for example, drugs, alcohol, sexual, etc.)? If so, please explain:

3.How does the applicant respond under difficult circumstances?

4.Are you aware of any health problems of the applicant or his/her family that might cause difficulty in the mission experience? If so, please explain:

5.What are the applicant’s strengths and outstanding abilities?

6.Does the applicant take responsibility well? Give example:

7.Comment on what you know of applicant’s faith commitment and relationship to the church:

8.How do you perceive the applicant in terms of adapting to an intercultural situation and relating to persons who may live in extreme poverty?

9.What degree of future success would you predict for the applicant in leading a group of young adults or youth on an international UMVIM trip?

  1. Do you have any reason to believe that the applicant should not participate in this cross-cultural mission experience? ○ Yes ○ No

Please explain:

Signature:Date:

Organization/Church:Position:

Print or type name:Phone:

Address:City:

State:Zip:Email: