Vision Teams Application

‘Read over the following application, and answer all of the questions as accurately as possible.
Then send three reference forms to the following people:
• A close friend, relative, or roommate
• A professor, teacher or employer
• Your pastor

Attach a recent photo, a copy of the front page of your passport, and email is to _______ by March
1st.

Name:

Permanent Address: Present Address:

Mobile Phone: Home Phone:

Birthday: Age: Email:

Marital Status: Occupation: Church You Attend:

Family Information

Father's Name:
Father's Occupation:
Father's Work Phone:
Father's Home Phone:
Father's Email:
Father's Address:

Mother's Name:
Mother's Occupation:
Mother's Work Phone:
Mother's Home Phone:
Mother's Email:
Mother's Address:

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Reference Information

Pastor:
Church Name:
Phone:
How Long Have You Been Acquainted:

Close Friend or Relative:

Phone:
How Long Have You Been Acquainted:

Professor, Employer or Spiritual Mentor:

Number:
How Long Have You Been Acquainted:

Education Information

College/University Attended:
Year of School Completed:
Major:
Foreign Language:
Foreign Language Proficiency:
Special Awards & Honors:
Special Skills, Abilities, or Musical Talents:

Medical Questions

Are you currently being treated for an injury or sickness?

Are you on any form of medication for any reason?
Are you allergic to any type of medication?
Are you required to be on any special diet?
Are you hypoglycemic?
Do you have any other allergies?
Do you ever sleep walk or have any other sleeping problems?
Do you have any physical disabilities or illnesses which would keep you from participating in
normal or rigorous activities?
Do you have or have you ever had seizure disorders?
Do you have or have you ever had asthma?
Do you have or have you ever had hay fever?
Do you have or have you ever had a heart murmur?
Do you have or have you ever had a kidney disease?
Do you have or have you ever had diabetes?

If you have answered yes to any of the above medical questions, please explain:

Do you have any other health concerns that could limit you in any way?

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Psychological Questions

Do you get nervous or upset easily?

Are you prone towards depression?
Do you have or have you ever had an eating disorder?

If you have answered yes to any of the above psychological questions, please explain:

Have you ever been diagnosed or treated for any psychological disorder, and if so, for what? Did
you ever take medication in response to this diagnosis?

Are you currently or have you in the past received counseling from a professional counselor
and/or mental health professional? Please explain.

Please disclose when and for what period of time you were/are under the care of a mental health
professional. Was/Is the counseling experience for you positive, negative or neutral? Please
explain.

By submitting this application I acknowledge that I understand that Tiny Hands International
does not provide coverage for short-term missionary outreach or other overseas activities. I
understand that if I am accepted to the Vision Team program I must purchase health insurance
that will cover me while in the country of service.

Name of Insurance Company:

Contact Person:

Medical Treatment Authorization and Release

In the case of a medical emergency, I, , authorize the calling of a doctor, and the
providing of necessary medical services in the event that I am injured or become ill. I understand
that Tiny Hands International and/or its staff members will not be held responsible for medical
expenses incurred, but such expenses will be my responsibility.

I, , give my consent for the director or a properly appointed staff member of Tiny
Hands International to secure the administration of medical treatment or medication in the case
of an emergency, and do further agree to the performance of such treatments as deemed
necessary by an attending physician at the discretion of a properly appointed staff member of
Tiny Hands International.

I, , understand that I will have to take full responsibility for medical liability and that
Tiny Hands International does not allow any short/long term involvement without proof of
insurance.

Applicant Disciplinary Agreement

By submitting this application, I agree that while I participate in this Tiny Hands International
Vision Team, I am responsible to abide by the rules set forth by the organization, its leaders and
supervisory personnel. Any serious infraction of the rules can result in my dismissal from the
program. In the event of dismissal, I agree to assume the responsibility of return costs to my

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home. I also agree to forfeit any possibility of a refund. I understand that such action would be
taken only under extreme circumstances.

Job History

Current Employer:
Address:
Date Hired:
Supervisor:
Contact Number:
Job Title:

Employer:
Address:
Dates Employed:
Supervisor:
Contact Number:
Job Title:
Reason for Leaving:

Employer:
Address:
Dates Employed:
Supervisor:
Contact Number:
Job Title:
Reason for Leaving:

Employer:
Address:
Dates Employed:
Supervisor:
Job Title:
Contact Number:
Reason for Leaving:

How did you hear about Tiny Hands International and about the Vision Team Program?

I have read and understand all forms:

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Essays

Please answer questions on a separate page. Answers for each question should not exceed one
page.

1. YOUR TESTIMONY: How and when did you become a Christian?

2. YOUR RELATIONSHIP WITH CHRIST: Describe your relationship with Jesus today.
How does this relationship affect you personally? How does this relationship affect the
way you interact with the world around you? What sacrifices have you made for the
sake of Christ?

3. YOUR DEVOTIONAL LIFE: Describe your devotional life. How often and how much do
you read the scriptures? How often and for how long to do you pray? How often do
you attend religious gatherings, and what is the nature of those gatherings?

4. YOUR SERVICE: ‘What have you done and are you doing to help the poor for the sake
of Christ? What Christian organizations have you been involved with in the past? Have
you had any overseas experience? Please describe the nature, frequency, and
duration of each of these activities.

5. GOD’S HEART: How does God view the fact that little girls are trafficked for sexual
exploitation, and children live on the street? How does He allow this to happen in a
world in which He is supposedly sovereign?

6. YOUR VISION: What is your reaction to the vision of Tiny Hands International? Why
do you want to participate on a Tiny Hands International Vision Team? What part of
Tiny Hands would you like to be involved in? What gifts or passions do you feel you
offer Tiny Hands International?

7. YOUR DREAM: If you could choose any kind of life for yourself, doing what you love
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 most and are most passionate about, what would it look like?

Short Term Programs Reference Form

Applicant's Name:
Your Name:
Your Address:
City, State, Zip:
Your Phone:
Your Email:
Relationship to Applicant:

The applicant is applying for a four-month Tiny Hands International Vision Team, which
will be comprised of about six members ministering among the poorest of the poor.
Since it is impossible for us to become personally acquainted with all of the applicants
before the trip, we would appreciate your confidential comments and will rely heavily on
your recommendation. Thank you for your help!

How long have you known the applicant? And in what capacity?

Is a love for God evident in the applicant's life? How have you seen this in his/her life?

In your opinion, does the applicant have a noticeable love for other people? How has this
been evident to you?

How has the applicant matured since you have been acquainted with him/her?

In your opinion, does the applicant respect authorities in his/her life?

What do you see to be the applicant's passions (i.e. what does he/she really enjoy
doing)?

What do you perceive to be the applicant’s greatest strengths?

What are his / her greatest weaknesses?

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Would he/she be an asset to a short-term mission team? Explain.

Is there any other information we should know that would better enable us to evaluate
the applicant?

Please rate the following qualities of the on a scale of 1 (worst) to 5(best) or write N/A.
FAITHFULNESS: How strongly can you guarantee that this person will do what he/she says
he/she will do?
Comments:
________
Score

DEVOTIONAL LIFE: To your knowledge, how active is this person’s devotional life? How well
does he/she know the scriptures?
Comments:
________
Score

PASSION and INITIATIVE: How strongly does this person become motivated about causes that
he/she is passionate about? When motivated, how active is he/she in pursuing that passion?
Comments:
________
Score

PERSEVERENCE: How consistently does this person follow through with what he/she begins?
How hard does he/she work to complete goals that are important to him/her? How disciplined is
he/she?
Comments:
________
Score

ABILITY TO GET ALONG WITH OTHERS: How well does this person get along with others?
How considerate and thoughtful is he/she?
Comments:
________
Score

EMOTIONAL STABILITY: How resistant to depression and other emotional problems is this
person?
Comments:
________
Score

CREATIVE PROBLEM-SOLVING: How well does this person creatively solve problems?
Comments:
________
Score

CAPABILITY: How well does this person follow directions? How resourceful is he/she?
Comments:
________
Score

FLEXIBILITY: How well does this person respond to new ideas and uncertain situations?
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 Comments:
________
Score

HUMILITY: How well does this person submit to authority? How slow to speak and quick to
listen is he/she? How teachable is he/she?
Comments:
________
Score

SEXUALITY: How is this person’s behavior with members of the opposite sex? Does
he/she avoid over-flirting and inappropriate behavior?
Comments:
________
score

Thank you for your time! Please e-mail this form to doug.tinyhands@gmail.com.

The deadline for Summer Teams is March 1st.

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