Servant Team Application

  1. Read over the following application carefully.
  2. Answer all the questions as fully as possible.
  3. You may want to answer the essay questions first, in a seperate text file, then complete the rest of the application.
  4. Send a link of the reference form (http://www.wordmadeflesh.com/forms/teams_ref.php) to:
    1. A close friend or roommate
    2. A professor, teacher or employer
    3. Your pastor
  5. Attach an image of your passport (you can do this on the next page, after you click 'Review Application' at the bottom of this form), or send two copies to the address below.
  6. Attach a recent photo (you can also do this on the next page, after you click 'Review Application' at the bottom of this form), or send a copy to the address below.
  7. Include a $35.00 application fee. The application fee is non-refundable and is payable via Check or PayPal.
  8. Give yourself enough time to complete the application before the deadline dates.

Word Made Flesh Servant Teams
P.O. Box 70
Omaha, NE 68101

General Information

First Name:
Middle Initial:
Last Name:

Permanent Address
Street Address:
City: State: Zip:
Home Phone:

School/Present Address
Street Address:
City: State: Zip:

Mobile Phone:
School Phone:
Email Address:

Birthdate: / /
Age:

Marital Status:
If Engaged:
Is Fiance Applying:
Expected Marriage Date:
If Married:
Marriage Date:
Maiden Name:

Occupation:
Church You Attend:

Family Information

Father's Information
Name:
Occupation:
Work Phone:
Home Phone:
Email Address:
Street Address:
City: State: Zip:

Mother's Information:
Name:
Occupation:
Work Phone:
Home Phone:
Email Address:
Street Address (if different):
City (if different): State: Zip:

Emergency Contact Information:
Name:
Relation:
Occupation:
Work Phone:
Home Phone:
Email Address:
Street Address:
City: State: Zip:

Reference Information

Pastor's Information:
Name:
Church Name:
Phone:
Street Address:
City: State: Zip:
How Long Have You Been Acquainted?

Close Friend's or Relative's Information:
Name:
Street Address:
City: State: Zip:
Phone:
How Long Have You Been Acquainted?

Professor's, Employer's, or Spiritual Mentor's Information:
Name:
Street Address:
City: State: Zip:
Phone:
How Long Have You Been Acquainted?

Education Information

Name of College/University Attended:
Years of School Completed:
Major:
Do You Speak A Foreign Language?
Foreign Language Proficiency: low high
Special Awards & Honors:
Special Skills, Abilities, or Musical Talents:

Medical Questions

  yes no
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?
Do you have any food restrictions?
(vegetarian, vegan, ovo-vegetarian, ovo-lacto vegetarian, etc)
Are you hypoglycemic?
Do you have any other allergies? (Please include any food 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 questions, please give an explanation below:

Do you have any other health concerns that would limit you in any way?
If yes, please explain:

Psychological Questions

  yes no
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 questions, please give an explanation below:

Have you ever been diagnosed or treated for any psychological disorder, 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.

If currently under the care of a mental health professional, please initial below.

I agree to contact my mental health professional and sign a confidentiality waiver that will allow the appropriate people at Word Made Flesh to contact my MHP if relevant to my application.

(If no waiver is available, please contact the Short Term Programs Coordinator.)

I agree to notify the office of Word Made Flesh in the event of any medical or psychological changes that would restrict my overseas participation. I also understand that the adult supervisors reserve the final word to restrict me from any activity that they do not feel is within my physical capabilities.

Medical Insurance Company Information

This is to certify that insurance company (policy number ) will cover while in the country of during the dates of through . In the event of injury or illness, all claims will be filed against a policy with the above-named company. I further understand that Word Made Flesh does not provide coverage for short-term missionary outreach or other overseas activities.

Name of Insurance Company:
Street Address:
City: State: Zip: Phone:
Contact Person:

Medical Treatment Authorization and Release
(Must be filled out for every applicant)

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 Word Made Flesh 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 Word Made Flesh 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 Word Made Flesh.

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

Applicant Disciplinary Agreement
(Must be filled out for every applicant)

I agree that while I participate in this Word Made Flesh Servant 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 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

Please complete the section below regarding your recent employment. Supervisors, as well as references, may be contacted.

Present Employer:
Street Address:
City: State: Zip:
Date Hired:
Supervisor:
Contact Number:
Job Title:

Employer:
Street Address:
City: State: Zip:
Dates Employed:
Supervisor:
Contact Number:
Reason for Leaving:

Employer:
Street Address:
City: State: Zip:
Dates Employed:
Supervisor:
Contact Number:
Reason for Leaving:

Employer:
Street Address:
City: State: Zip:
Dates Employed:
Supervisor:
Contact Number:
Reason for Leaving:

Essay Questions

Answer the following questions in a separate text file or Word document; you will be asked to attach that file on the Review page. Each response should be no more than one page.

General Information

  1. Relate your own personal biography experience incorporating:
    • Family background/upbringing and how that has affected who you are today
    • Current relationship with parents, siblings, roommates
    • Significant experiences that have contributed to the person you are today
  2. Why do you want to participate on a Word Made Flesh Servant Team?
Spiritual Information
  1. Please tell us about your conversion. Include where you were at the time and how your conversion happened.
  2. 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?
    • How do you pursue spiritual growth?
    • What has God been teaching you recently?
  3. Describe God's passion for the world as you see it. What does this imply for you as a believer?
Ministry Experience
  1. What Christian organizations have you been involved with in the past?
  2. What organizations are you currently associated with? What is your involvement?
  3. Have you held any positions of leadership? What were your responsibilities?
  4. Please describe any ministry experience you have had overseas. Include the dates and duration of the trip(s), your activities, and briefly describe the impact these experience(s) had on you.

Check Off List

Check off all information to insure your application is complete.
How did you hear about Word Made Flesh and about the Servant Team Program?
Contact Name:
Please choose your country of preference, along with the date (ex. Bolivia Fall 2007). Available teams are listed here. Please note, the final choice will be made by the Word Made Flesh office, but your input will be an important part of choosing the teams. Team Choice: Why was this your choice?
US domestic airport travel will need to be arranged to/from (closest city)? city) (Please pick an airport that will be closest to you at the time of departure)
Recent photo (you will be asked to attach it on the next page)
Image of current passport (you will be asked to attach it on the next page)
Essay questions completed (you will be asked to attach a file with your answers on the next page)
Reference form sent to the appropriate people (click here to view the reference form in a new window)
$35.00 non-refundable application fee. Payable via Check or PayPal

I state that I have read and understand all the forms in the Servant Team application. In addition, I attest that the information given therein, to the best of my knowledge, is true and as complete as possible.