Trek Program Preference
Which program are you applying for:

First Choice:	1st choice Bangkok Cairo (Sudanese) Cairo (Mokattam) Kolkata Lima Manila Mexico City North Africa Phnom Penh Tegucigalpa
Second Choice:	1st choice Bangkok Cairo (Sudanese) Cairo (Mokattam) Kolkata Lima Manila Mexico City North Africa Phnom Penh Tegucigalpa
Third Choice:	1st choice Bangkok Cairo (Sudanese) Cairo (Mokattam) Kolkata Lima Manila Mexico City North Africa Phnom Penh Tegucigalpa
Personal Information
Name:	(first, middle, last)
Nickname:	(or name donors may use for you)
Email address:
Gender:	Male   Female
Marital status:	Single Engaged Married Separated Divorced (not a basis for acceptance or rejection)
Ethnic heritage:	(not a basis for acceptance or rejection)
Spouse or fiancé name:
Your birthdate:
Place of birth:
I am a citizen of:
If a non-US citizen, type and expiration date of visa:
Visa Number:
How did you hear of Global Urban Trek?
Address during school year:
Street Address:
City, state, zip or postal code:
Country, if outside U.S.
Phone (including area code):
	this is campus/university housing
Don't send mail here after:	(MM/DD/YYYY)
Permanent address:
Street or Box:
City, state, zip or postal code:
Country, if outside U.S.
Phone (including area code):
	this is my parents' address
Use this address beginning:	month/day/year
Will you return to your school address next fall?	Yes   No
If yes, approximate date:	MM/DD/YYYY
Academic Information:
School:
	College/University Bible College/Seminary Voc/Business School Jr/Community College High School
Highest level of attendance:
Graduation date:
Major:
Why did you choose this major?
Church Information:
Your local church name:
Senior pastor:
Denomination:
Reference Information: Please provide us the names and phone number of the three people you will give reference forms to: (you will have an option later to email them a reference form or print a form that you can give to them.) A. Pastor
Name:
Phone:
B. IV Staff Worker (or equivalent Christian leader)
Name:
Phone:
C. Roommate or Peer
Name:
Phone:
Travel Information
Describe any medical problems, physical limitations, allergies, or medications that would prevent you from engaging in rigorous activity or that we should know about for your health and well-being. (not a basis for acceptance or rejection)
Do you have a passport?	Yes   No
If you have a passport, what is its expiration date?
If you have a passport, where was it issued?
Are you covered by a major medical insurance policy (over $50,000)?	Yes   No
Insurance agency:
Note: If you are not covered by insurance, you will be required to purchase trip insurance.
Emergency Contact Information
Name:
Relationship:
Address:
City/State/Zip:
Phone:
Has this person accepted your involvement in this program?	Yes   No

1. How and when did you become a Christian?

2. Have you had any experience discipling others? If so, please describe.

3. If an InterVarsity student, what IV training events have you attended?

4. What leadership positions have you held?

5. What is your current involvement in evangelism? Be specific.

6. Have you had specific training in evangelism? If so, please describe.

7. Give a brief statement or outline of your understanding of God's plan of Salvation.

8. What is your current involvement in world missions? (e.g., missions study/prayer group, friendship with international students, regular personal prayer for specific missions concerns, read missions books and periodicals, etc.)

9. What experience have you had in cross cultural relationships? (e.g., previous travel or residence overseas, involvement with students from other countries or ethnic groups, etc.)

10. Why do you want to participate in the Global Urban Trek, and explain your interest in choosing a city?

11. The goal of the Trek is to call people to long-term service to the poor. Where do you think God may be calling you? Why do you think the Trek goal will help you?

12. What languages do you speak (other than English)?

13. List your skills, musical abilities, special talents, ministry experience.

14. Please evaluate yourself in the following areas:

Servanthood:	Excellent  Good  Average  Weak
Team Player:	Excellent  Good  Average  Weak
Flexibility:	Excellent  Good  Average  Weak

15. What do you hope to gain by going on the Trek?

16. Describe a time recently when God was directing you to obedience or action. How did you respond?

17. Give a recent example of a conflict with an authority person and a peer. How did you deal with these conflicts?

18. What do you see as your strengths?

19. What do you see as your weaknesses?

20. Additional Comments:

Please enter the text above: