Fill out the application below to apply for Spring Break missions with Campus Ministries by October 24. You will need to make a deposit in the CM office before your application is complete. Make sure you have health insurance information available before beginning this application. CM Spring Break Missions Please fill out this form completely. Step 1 of 4 25% Name*List name as it appears on your passport or drivers license. First Last *MiddleBirth Date* MM DD YYYY Home (non-OBU) Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country OBU Box Number*OBU ID Number*Cell Phone*OBU Email address* Major*GPA*Church Membership*Local church you attend:*How involved are you at either your home or local church?*Answer based on the church you attend most during school.Not very involvedRegularly involvedVery involvedParent/Guardian Name* First Last Parent/Guardian Email* Parent/Guardian Home Phone*Parent/Guardian Cell Phone* Health Information*How is your health in general?ExcellentGoodFairPoorIf you have now, or have had in the past, any of the following, please check the corresponding box:* Asthma Heart Trouble Diabetes Hypoglycemia Nervous disorders Tuberculosis Stomach trouble Migraines Epilepsy Phyciatric Council Physical disability None of the above List any medical conditions not mentioned above that we should know about:InsuranceName of Health Insurance companyPolicy NumberInsurance Policy Holder First Last Insurance Company Phone NumberEmergency Medical Permission*I certify that I give permission for the trip leaders of the CM Spring Break team to obtain necessary medical attention so that I may receive medication and treatment if necessary in the event of illness or accident and I am unable to make the decision myself. I give the team leaders permission to make a decision concerning emergency treatment. I agree Previous Mission TripsBriefly describe any prior mission trips you have participated in Personal Faith*In the space below, describe your relationship with Christ--how it began and how it has developed in college: Do you have any special skills or gifts that you feel will be useful on this trip?*Teaching, music, evangelism, sports skills, etc. What is the attitude of our family about your participation on this trip?*Very SupportiveSomewhat SupportiveNeutralSomewhat OpposedVery Opposed Reference #1* First Last Reference #1 Email Address* Reference #2* First Last Reference #2 Email Address* I understand that if I am chosen for this team:*Please acknowledge the following by checking each box I am responsible to raise or pay the cost of the trip by the communicated deadlines I will attend all team meetings (usually 3-4 meetings prior to spring break) I will respect the team leaders and understand I will be under their supervision I will follow the guidelines of the "Tiger Handbook" I realize I may incur additional expenses (luggage fees, traveling meals) I will regularly check my Tigermail for mission trip information PhoneThis field is for validation purposes and should be left unchanged.