Global Mission Encounter 2019-La Sagrada Familia Survey

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* 1. Please provide your contact information:

Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. What is your date of birth? (please use format MM/DD/YYYY)

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* 3. Do you have a valid passport? (Passport must not expire for at least 6 months after the return date of your trip.)

Yes

Please Note: If applying before the application deadline, you do not need to have a passport to apply for the program. However, you will need to have a passport before April 1, 2019 as it is needed to book your flight.

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* 4. If you already have a valid passport, please enter the following information:

Full name exactly as it appears on your passport:

Passport Number:

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* 5. Emergency Contact Person(s):
(at least one person's name and phone or e-mail address is required)

Contact Person #1 Name:

Contact Person #1 Telephone Number:

Contact Person #1 E-mail Address:

(optional) Contact Person #2 Name:

(optional) Contact Person #2 Telephone Number:

(optional) Contact Person #2 E-mail Address:

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* 6. Do you have any health or dietary restrictions?

Yes (please specify)

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* 7. Do you have previous international mission experience?

Yes

If you answered yes, please indicate location(s) and date(s):

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* 8. Do you speak any Spanish or Creole? (you can indicate your level in questions 7 & 8)

Yes, Spanish

Yes, Creole

No I do not speak any Spanish or Creole

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* 9. If you speak Spanish, please indicate your level of proficiency:

Beginner

Conversational

Fluent

Interpreter

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* 10. If you speak Creole, please indicate your level of proficiency:

Beginner

Conversational

Fluent

Interpreter

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* 11. If you are a member of a parish, please enter the name and location of that parish:

Parish Name:

Parish City:

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* 12. Are you a member of a young adult group or campus ministry program? If yes, please list.

Yes (please specify)

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* 13. There may be a light construction aspect to this trip. Do you have any light construction or related experience (house painting, electrical, etc)?

Yes (please specify)

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* 14. There may be a music ministry component to this trip. Please indicate any music experience you have (check all that apply)

Play an instrument

Sing in English

Sing in Spanish

Read Music

Teach Music

Perform in a Choir or Band

I do not have any music experience

Other (please specify)

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* 15. If you chose any items above, please provide details about your music experience (leave blank any items that do not apply to you)

Vocal Range:

Instruments Played:

Teaching Experience:

Type of Choir or Band:

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* 16. All pilgrimage participants must complete the Safeguarding Our Youth Training before the trip.

Have you been through the Safeguarding training?

Yes

If yes, please provide the date and location of the training:

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* 1. Please provide your contact information:

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* 2. What is your date of birth? (please use format MM/DD/YYYY)

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* 3. Do you have a valid passport? (Passport must not expire for at least 6 months after the return date of your trip.)

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* 4. If you already have a valid passport, please enter the following information:

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* 5. Emergency Contact Person(s): (at least one person's name and phone or e-mail address is required)

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* 6. Do you have any health or dietary restrictions?

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* 7. Do you have previous international mission experience?

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* 8. Do you speak any Spanish or Creole? (you can indicate your level in questions 7 & 8)

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* 9. If you speak Spanish, please indicate your level of proficiency:

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* 10. If you speak Creole, please indicate your level of proficiency:

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* 11. If you are a member of a parish, please enter the name and location of that parish:

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* 12. Are you a member of a young adult group or campus ministry program? If yes, please list.

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* 13. There may be a light construction aspect to this trip. Do you have any light construction or related experience (house painting, electrical, etc)?

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* 14. There may be a music ministry component to this trip. Please indicate any music experience you have (check all that apply)

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* 15. If you chose any items above, please provide details about your music experience (leave blank any items that do not apply to you)

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* 16. All pilgrimage participants must complete the Safeguarding Our Youth Training before the trip. Have you been through the Safeguarding training?

* 5. Emergency Contact Person(s):
(at least one person's name and phone or e-mail address is required)

* 16. All pilgrimage participants must complete the Safeguarding Our Youth Training before the trip.

Have you been through the Safeguarding training?