Puerto Rico Application Packet (must currently be a Junior or Senior to apply)

This trip is sponsored by World Impact & Flipside Ministries

Puerto Rico 2016 Basics (At this point dates and information is tentative so please be patient as we work with our international workers to solidify details.)

Mission Goal:

To partner with the Puerto Rican Alliance Church as well as a Christian ministry called Camp Caribe. Camp Caribe is focused on evangelism and training Christian leaders to return to their home churches. They also run a community center for neighborhood kids. This is where we will be primarily working. We will be running a week long VBS at the community center and doing other work projects to bless the camp.

Location: Juana Diaz, Puerto Rico (about an hour from San Juan). Housing: Camp Caribe. Transportation: Flights to Puerto Rico and 15 passenger vans in country. Dates: June 22nd-July 4th, 2016

*please be available three days on each end of these dates as we search for the cheapest flight dates.

Informational Meeting: November 22nd in the Youth Center @ 12:15pm. Cost: Approx. $1,500 -2,000 dollars depending on flights. Application Deadline: This application is due in the youth registration box no later than

Sunday Dec. 13th with a $100 non-refundable check made out to Salem Alliance. Please write in the memo line “World Impact” with your name and Puerto Rico 2016.

Interviews:

When you submit your application there will be a sign up sheet for interviews on the welcome desk. Pick a day and time that works for you. Interviews take place December 15th-18th.. They are 20 minutes long and are done individually in Ashley Dalen’s office. -You will receive a call on December 18th letting you know if you made the team.

Commitment:

We will have a team meeting every month starting in January up until we leave. The time of these meetings will be determined once the team is decided. Each member will be responsible for sending out support letters and fully raising their support. You will also be required to participate in the Great Expectations Fundraiser February 10-12th. Money raised will go towards each individual’s balance of the trip.

Optional Opportunity: This trip does intentionally happen right before the LIFE conference in Kansas City. If you would like to participate in both of these trips there will be a leader flying directly from Puerto Rico to Kansas City to meet up with that group as well as a leader flying the rest of the team home to Portland. If a student would like to do both, they will need to fill out a LIFE application as well. The cost for LIFE will be adjusted because of the different airfare. If you have any further questions please call or email Ashley Dalen [email protected] 503-581-2129 Brandon Miller [email protected] 503-581-2129

SHORT TERM Missions Application PLEASE ANSWER ALL QUESTIONS COMPLETELY Trip applying for: (places/dates) Application Completion Date:

NAME as it appears on passport: Address:

City/State/Zip: ______________________

Home Phone:

Cell Phone:

Email Address: Date of Birth: Marital Status: Children:

No

Gender: Married-Spouses Name: Yes: Number

Male

Female

Single Ages

If you are a minor, do you have parental approval for this venture?

Yes

No

PASSPORT INFORMATION: Do you have a current passport? Yes No Applied for ___________________ (date) Complete Passport Name (all): ___________________________________________________ Passport Number: ___________________________________________________ Issue Date: _________________________________ (mm/dd/yyyy) Expiration Date: _________________________________ (mm/dd/yyyy)

Current status: Student: (grade)

(location)

Employed: (company)

(position)

Employer’s Address & phone: Other: Professional License: Type:

Expiration Date: (medical personnel, teacher, etc.)

Attach a copy of current license Please be in prayer with us as we select the team with just the right gifts and personality for each World Impact Team.

Spiritual Relationships: 1. How and when did you first come to know Jesus Christ as your Savior?

2. Describe your devotional life and present relationship with the Lord. What helps you keep this relationship fresh and alive on an ongoing basis?

3. What do you do when you have conflict with someone? How do you handle confrontation?

4. List groups that you plan to connect with to share this short term experience before and after your trip (e.g. community groups, Bible study groups, etc.).

5. Describe your present church involvement: Occasional Attendee Bible Study Regular Attendee Community Group Salem Alliance Member Evangelism

Music/Worship Christian Education Missions

6. Where/how are you currently serving? ____________________________________________________________________________________ ____________________________________________________________________________________ 7. Have you ever travelled internationally (outside the USA) before? Explain:

8. What motivates you to apply for short-term missions at this time?

9. What abilities/gifts do you bring to this short-term missions project/team?

10. As a present indication of my missions interest I am: Praying regularly for or corresponding with specific missionaries Reading missionary biographies or books Pursuing an organized course of study on world missions Subscribing to a missions periodical/bulletin (e.g. Alliance Life, Alliance Video Magazine) Developing a friendship with an international student Financially supporting an overseas missionary (Faith Promise) Giving to Alliance missions (Great Commission) Corresponding with mission agencies about service opportunities Exploring further training Other: Health Background: 1. List all health conditions for which you are receiving treatment.

2. List all medication (over-the-counter or prescriptions) you take currently or occasionally. Please explain why each is used.

3. Do you have any dietary restrictions?

4. Are you able to skip an occasional meal?

Yes

No Explain, if yes:

Yes

No Explain, if no:

5. Do you have any health conditions which may cause difficulty under heavy work and heat?

Emergency Contact Information: Name: Home Phone: Relationship Email address:

Cell Phone:

Home Phone: Relationship Email address:

Cell Phone:

Name:

References: Please list three local references (not family members). INCLUDE one SAC pastor or elder and at least one additional person from Salem Alliance Church:. ❶ Name: Address: Home Phone: Email Address: Relationship

Cell Phone:

❷ Name: Address: Home Phone: Email Address: Relationship

Cell Phone:

❸ Name: Address: Home Phone: Email Address: Relationship

Cell Phone:

Participant Expectation: Should my application be accepted, I agree to be bound by the bylaws and policies of Salem Alliance Church (and the sending Mission organization) and to refrain from unscriptural conduct in the performance of my services on behalf of the church. I recognize that by becoming a part of this short-term project I am placing myself under the authority of church leadership. At the completion of this World Impact trip, I agree to submit to a written evaluation covering logistics and personal spiritual impact. Should my application be accepted, I will participate in team building and preparation activities, prayer, trainings, fund raising and reporting our mission’s trip upon my return. World Impact expenses for trips are generally financed through 1/3 personal funds and 2/3 team member’s prayer letters to family/friends, fundraising, and/or personal resources. Each team member is expected to send out a prayer letter before and after their trip. Ultimately, you will be responsible for raising the full amount of your portion of the trip/team expenses. Funds that may be raised are to be used at the discretion of Salem Alliance Church. A $100 deposit is due with this application, which will be held until such time as you are accepted or not on the team Signature: Date:

PLEASE INCLUDE THE $100 DEPOSIT Please return completed application (with $100 check payable to Salem Alliance Church) to: Salem Alliance Church Missions Advisory Council – Attention: Trish Allbritton 555 Gaines St. NE, Salem, OR 97301

Criminal History Screening Consent Form and Background Statement (Youth 14 through 17 years old)

INSTRUCTIONS: Please answer all questions on this form. Do not leave any areas blank. If information requested does not apply to you, write “NA” for not applicable or the word “none.” By providing your social security number, we will use it to ensure that we do not misidentify you. Giving your social security number on this form is voluntary. If for any reason we are unable to complete this background check, we may ask you to provide additional means of identification. Your social security number will be used only as stated above. State and federal laws protect the privacy of your records. Falsifying or not disclosing information may result in disqualification of your application or termination of your volunteer assignment or employment. If in doubt, we suggest that you disclose and explain rather than conceal. If you answer “no” to any questions based on an “expungement,” “order setting aside,” or “sealing” of a record of a conviction or conditional discharge, you must personally verify with the court directly involved that the expungement, setting aside or sealing actually has taken place. An erroneous belief that a conviction has been expunged, set aside or sealed, when in fact it has not, will be deemed a false statement. If you answer “yes” to questions 1-4 listed on the back, a certified true copy of the charging instrument (e.g. criminal complaint, indictment, or citation) and the court’s final judgment must accompany this application. (ADULTS: Backgrounds will be verified back to your 18th birthday.) COMPLETE THE FOLLOWING INFORMATION: (please print clearly) Legal Last Name:

Legal First Name:

Date of Birth (MM/DD/YR):

Full Middle Name: Gender:

Social Security/Resident Alien Number (OPT.): Drivers License/Permit/ID Number:

Female

Male

Place of Birth: State Issued By:

Physical Address: Street

City

State

Zip

Street

City

State

Zip

Mailing Address: Number of years at current residence:

If less than three, state of prior residence:

Home Phone:

Cell Phone:

Maiden/all other names previously used: How long have you lived in Oregon (in years)? List all states where you have previously lived and during which years: ________________

DEPARTMENT SUBMITTED TO:

CONTINUED ON BACK…

PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS: 1.

A.

Have you ever been arrested, accused or convicted, plead guilty, plead nolo contend ere (no contest), or received diversion to any felony, misdemeanor, or violation, in any municipal, justice, state, or federal court? If yes, please explain:

Yes

No

B.

Did you complete all court requirements (e.g. probation, community service, payment of fines, etc.)? If no, please explain:

Yes

No

2.

Have you been arrested for a crime for which there has not been an acquittal or dismissal?

Yes

No

3.

Have you ever had a stalking or restraining order placed against you?

Yes

No

4.

Have you ever been charged civilly for any drug-related offense?

Yes

No

5.

Have you ever been accused of, or charged with committing any act of neglecting, abusing, molesting or battering a child or adult?

Yes

No

6.

Have you had any type of sexual relationship with a minor or vulnerable adult?

Yes

No

7.

Have you ever been approved as a volunteer for a government agency or non-profit organization? If yes, please list:

Yes

No

Authorization to Release Information (Release from Liability and Waiver) To any law enforcement agencies, civil records authorities and Salem Alliance Church: I authorize you to release to Salem Alliance Church any and all information and civil or criminal records naming me, including all entries where I am named as being arrested, as a suspect, as being cited for any crime, violation, infraction or offense, or as otherwise involved or named in any report by any member agency of your organization. The information that I have provided is accurate to the best of my knowledge and may be verified, if necessary by contacting persons or organizations named in this application, or by contacting any person or organization that may have information concerning me, or by conducting a criminal background check. I hereby release and agree to hold harmless from liability any person or organization that provides information. I also agree to hold harmless Salem Alliance Church and employees and volunteers thereof. Applicant Signature: Parent Signature (if 17 or under): For Church Use Only: Criminal History Check:

Date: Date: ________________

Date: