Short Form Application

Personal Data

Type of Health Service Assignment:

Healthcare Mission Trip
Short-term Independent Service (2 weeks to 12 months)
Long- term Health Missions Service

Please choose one of the above

First Name:

MI:

Last Name:

Address Line 1:

Address Line 2:

City:

State/Province:

Postal Code:

Country:

Phone Number:

Email:

Placement

Where would you like to serve:

What type of placement/ministry interests you?:

When will you be able to begin an assignment?:

Occupational Experience

Health Care Profession:

Specialty:

*The Christian Health Service takes no credit for work done by any facility or missionaries who serve with them. We seek to make known the work God is doing through mission facilities and their missionaries around the world. By doing so we seek to: 1) help those who are called to go discover where God maybe calling (short or long term), 2) help those who are called to give identify missionaries and facilities for financial partnership, 3) help those who are called to pray connect with healthcare missionaries needing prayer support.

Serve

Pray

Give

Short Form Application

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Medical Mission Trips

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