Short-Termer Request to Depart to Field
Please return this form 1 month prior to
Your departure. Consult the Check List
in your Deputation Manual.
Name:
1. Departure:
· Date:
· From:
· Time of Flight:
· Airline/Flight Number:
· Arrival Date:
· Arrival Time:
2. Passport Information:
Name: / Number: / Place of Issue:3. Address information:
Field Address:
Phone:
E-mail:
This address is effective:
Permanent US Address:
Phone:
E-mail:
4. Checked with a missionary on the field and/or the embassy for what is needed for a visa.
5. Letter of guarantee:
6. Current support:
· “NEED” level $. Support promised $.
· List of supporters (with addresses) given to GFA? If not, attach one.
7. Passage funds in?
8. Have you begun estimated quarterly tax payments to the IRS?
9. Medical check-ups completed?
Check-ups Eye checks Shots Dental checks
10. Medical Insurance
Limited power of Attorney given to GFA
Form and payment given to GFA if a short term missionary
11. Do you have any debt(s): If so, to whom:
For: Amount: Repayment schedule:
12. Arrangements: (Only if we receive any $$ for you here at the office)
· Financial: First deposit following arrival starting with
No changes from the usual arrangements.
Deposit the balance to checking account.
· Bank name:
· Account number and bank routing number:
Other:
· Packet: (Any mail we receive for you at the office)
Hold packet in the office for pick-up before I leave.
Please send packet to:
13. Noted to register with the US Embassy when I arrive on the field.
14. Book summaries turned in to Mr. Crawford. (Only if applicable)
Secret_1/forms/DepartFormSTemail.doc. 09/9/08