MEDICAL MISSIONS APPLICATION

Instructions:

  • Complete the online form and submit.
  • Scan your passport information page and e-mail to MVI.
  • Scan your medical license and DEA certificate and e-mail to MVI.
  • Download the Release of Liability form and either mail or fax to MVI.

OR

  • Download the Medical Application and Release of Liability form.
  • Send a photocopy of your passport information page.
  • Send a photocopy of your medical license and DEA certificate.
  • Fax or mail the Medical Application, Release of Liability, license, certificate and passport information page to MVI.

Country for which applying: Trip date:
Passport name:
Street address:
City:
State:
Zip Code:
Phone:
E-mail:
Birthday:

Field of experience - medical, dental, nursing:
Areas of particular speciality:
Medical/Dental/Nursing school:
Year graduated:
Years in current speciality:
Where licensed:

Are you a U.S. citizen?
If not, where is your citizenship?
Do you have a current passport?
What is your passport expiration date?

What specialized training/experience have you had that may be of value on the mission field?
What kind of formal witnessing training have you had?

Have you been on a mission trip before?
What organization did you go with?
What country(ies)?
What language(s) do you speak?

Are you a Christian?
How long have you been a Christian?
What church do you attend?
Upon what are you depending for your salvation?
Briefly describe your relationship with Jesus.

Why do you want to be a part of a missions team?
What are your strengths/weaknesses?
How do you see your strengths/weaknesses as being a help/hindrance while on the field?

Do you have any medical problems about which we should be made aware?
Are you taking any medications (please list)?
What current inoculations do you have?

Medical Application Download

Release of Liability Download