Global Impact - Application

Complete the following form if you are interested in participating in a Global Impact mission trip.

Name (as it appears on your passport):*

Address*

City, State, Zip Code:*

Home Phone:*

( ) -

Work Phone:

( ) -

Cell Phone:

( ) -

Email Address:*

Project/Trip Name:

Trip Date/Location:

Emergency Contact:*

Current member of New Cov?*

Yes
No

If Yes, since:

If No, Explain:

Are you in a small group?*

Yes
No

If Yes, which one?

If No, give the name of a New Cov member who knows you well:

Describe any current medial conditions you have and/or any medications you take on a regular basis:*

Have you been on any kind of mission trip before?*

Yes
No

If Yes, briefly describe when, where and what you did:

Have you received financial support from New Cov for a previous gobal impact trip?*

Yes
No

Describe your motivation for wanting to participate in this project:*

Describe how you came into a personal relationship with Christ and what is helping you grow as a Christian right now (in 100 or more words):*

Confirmation Code:

Enter the code shown in the box before clicking on submit.

Note: Fields marked by an asterisk (*) are required.

Visit our other Global Mission pages for more information.