Clone of FIA - Individual Application

FIA - Individual Application (domestic)

Completion of this form indicates your desire to serve a mission field in North America.
Personal Information - Step 1
Full name (as it appears on driver's license or picture ID) *

Prefix First Name Middle Name Last Name Suffix
Social security number (required for long-term mission assistance)
Sex *
Marital status *

Permanent home address (not college address, if student) *

Congregation address

Volunteer Service Information - Step 4
If you are responding to a specific volunteer opportunity, state which one
I am able to serve...
from

- Month - Day Year
to

- Month - Day Year
My previous experience/training includes
list one per line
I am able to speak the following language(s) (rate fluency - high or low)
list one per line

>> FOR MINORS

If you are not a minor, click Save & Go to the Next Page.
Parents/guardians: For your minor to be part of an FIA mission trip, WKW must have a completed permission slip on file...Click Here
Each team with volunteers under 18 years of age requires a chaperone. It is preferred to have a female chaperone for female volunteers and a male for male volunteers. One chaperone may sign for no more than six students. NOTE: Each chaperone must complete and submit an FIA - Individual Application (domestic).
Chaperone's name

Prefix First Name Last Name

>> FOR COLLEGE STUDENTS

If you are not a college student, click Save & Go to the Next Page.
College
Grade level
Campus pastor

First Name Last Name
Campus pastor phone

- Area Code Phone Number
Campus pastor e-mail
NOTE: If you cancel after being assigned to a team and flight arrangements made, you will be charged for your unused ticket.

>> FOR THOSE WILLING/ABLE TO DRIVE

If you are not willing or able to drive to your ministry opportunity, click Save & Go to the Next Page.
Do you have a car with which you could transport a team?
Car license number/state
Driver's license number/state
Auto insurance company
Insurance company phone

- Area Code Phone Number
Policy number

Authorization - Step 7
Electronic signature *

First Name Last Name
Application completed

- Month - Day Year
at
: Hour Minutes
By clicking the Submit button, I do not hold the Wisconsin Evangelical Lutheran Synod, the WELS mission boards, WELS Kingdom Workers, the host congregation/ministry, the high school, or congregational youth group responsible for any accidents incurred while participating in this service activity.
Should be Empty:

FIA - Individual Application (domestic)