Mission Trip Application Spring Break 2018 Mission Trip Week of March 11-17, 2018* This application will close at 11:59pm on Wednesday, January 24, 2018 CONFIDENTIAL APPLICATIONName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Age in March 2018*Are you willing to drive a 7-passenger van?*YesNoDate of Birth* Year in School*Major*Did you attend the Mission Trips Callout?*YesNoWhy do you want to go on a mission trip with St. Tom’s?*What personal qualities will you bring to the group, and what gifts and talents you are willing to share (for example: teaching, construction, photography)?*Have you ever been part of a mission trip, service work, or social justice ministry?*YesNoList the year and length of any mission trips, service or justice work you have participated in.*What are two things you learned from your prior experience?*Would you like to be considered as a student leader or one of the trips?*YesNo2018 Mission Trip Locations: Please order your preference (first choice on top)Drag and Drop to reorderClear Creek, OK (Monastery)Flint, MI (Community Outreach/Construction)Jonestown, MS (Roofing/Habitat)New Orleans, LA (Community Projects/Construction)Pensacola, FL (Habitat)Health InformationGeneral health condition*ExcellentGoodFairDo you have any physical, mental, or emotional conditions that the leadership team needs be aware of during the trip (e.g., allergies, disabilities, heart conditions, chronic illness, asthma, medications)?*Note: Information you provide about your health will be treated as confidential. A health condition will not necessarily prevent you from participating in the trip. The information you provide will help in assessing your special needs. Other Information It is very important that you have the support of your parents or legal guardian to go on a mission trip.Have you talked to your parents or legal guardian about the possibility of participating?*YesNoDo your parents or legal guardian support your desire to participate in a mission trip?*YesNoThe TOTAL cost of a mission trip will be $350-450 per person. This includes travel, gas, lodging, meals, snacks, drinks and site fees. 1/3 of your trip cost will be raised through your help in group fundraising efforts and encouraging St. Tom’s parishioner support. 2/3 of your trip cost will be your individual responsibility. With that said, with an average effort of writing family, friends and your home parish, 100% of your cost, SHOULD and CAN BE fundraised. Sample letters and ideas will be provided. An exact cost of the trip will be provided upon acceptance.Are you able to provide at least $150 of the trip cost from your own fundraising and resources?*YesNoAre you willing to commit to selling two tickets to the Fundraising Dinner on Friday, February 9 and to work at least one, one-hour shift preparing for, serving or cleaning up the Dinner between 3:00-10:00pm? (Workers must buy a ticket to eat at this dinner.)*YesNoEmergency ContactContact Name*Contact Relationship*Contact Phone*Contact Email* You will find out which trip you are on at the mandatory meeting on Tuesday, January 30 at 6:15pm in Newman Hall!