Uganda Confidential Participant Application

The Plan

Crossroads Church of God will send a mission team to Uganda during the first two weeks of August, 2025. This team will consist of persons from Crossroads Church of God. The team will include up to 16 participants. Youth who will be 17 by the departure date and accompanied by a parent or legal guardian may also apply. Selection of the team will be based on individual applicant’s spiritual journey, passions, capabilities, as well as team compatibility and dynamics. Applications should be turned in along with a $200 deposit (nonrefundable) by November 17th, 2024.

Contact Information

Name

Gender

Male Female

This address will receive a confirmation email

Phone

Address

Occupation

Emergency Contact Information

Name

Relationship to you

Phone

Citizenship / Passport

Are you a US Citizen?

Yes No

Do you have a passport?

Yes No Applying

Passport #

Place of Issue:

Expiration Date:

Birth Date

Personal Information

List and comment on two personal strengths.

List and comment on two personal weaknesses

Share your relationship with Crossroads Church of God and what ministries you are involved in, if any. (When did you start attending Crossroads? Are you a regular attender? Are you involved in any life group or ministry at Crossroads?

Share your faith journey. (What are you learning about God? What are you wondering about? What have been some of the benchmarks of your journey thus far?)

Share why you’ve decided to apply to be a part of this trip. (What personal knowledge of or interests do you have in missions or Africa? What prompted you to apply? What do you hope to share? What do you hope to gain?)

Describe any of your cross-cultural living, training and/or travel experiences. (What did you learn? What types of difficulties did you experience? Do you speak other languages?)

How well do you deal with uncertainty and change? How well do you take instruction? Change? Would you be willing to forego personal preferences to honor the culture of the people we are serving and your team?)

References

To assist us in evaluating your application, we would like to be able to reference persons who know you well. Please provide us with names of individuals who are not related to you, that have shared in a part of your journey and can speak of your life and character.

Name

Phone

Name

Phone

Confidential Medical Questionnaire

PLEASE READ CAREFULLY

Although the Stevenson’s, our missionary hosts, provide beautiful hospitality, missions work anywhere, especially in Uganda, may be at times extremely strenuous and stressful. It will include days of travel including long flights, confined and arduous van, bus and small boat travel. Travelers are almost always required to carry their own luggage. Restrooms are not always readily accessible and are sometimes primitive in nature. We will eat whatever food is provided us. In the missionaries’ home, the food will be more traditional, but in the villages we will partake of the food that is customary for their culture. There is a considerable amount of walking, and the trip will be physically rigorous at times. Conditions in much of the world can sometimes be very hot, and the air quality can be poor in many locations; this might affect your overall strength and energy.

Any of the above factors could aggravate certain health conditions, and the medical facilities in the Africa are limited. We reserve the right to request a medical release statement from your physician.

1. Do you place any limits on yourself to avoid physical or medical problems? Do you have any hearing, vision, or mobility limitations?

2. Have you had any surgery or major health problems in the past? If so, briefly explain and give approx date:

3. Have you ever experienced any psychological or emotional conditions? (ie: eating disorders, bipolar disorder, depression, etc.)

Yes No I would prefer a phone call to discuss this answer

(If yes, please explain and indicate if you are currently being treated by a physician.)

4. If applicable, in your opinion, would any of the conditions listed above limit your ability to perform the ministry for which you have applied?

Yes No

Have you discussed this trip with your physician?

Yes No

5. Are you currently taking or do you regularly take any medications? If so, please list the drug name(s), what each drug treats, and note which are prescription and non-prescription. Also list if medication requires special storage (i.e. refrigeration).

6. Do you have any allergies or special dietary needs? If so, please explain.

7. Do you snore or have any sleep disorders? (This is to help with sleeping arrangements and will be kept confidential).

Uganda Confidential Participant Application

Description

Please Fix the Following