Project MedSend Preliminary Application

Item Information
Your Name:
  Permanent Home Address
Address:
 
City:
State:
Postal Code:
Home Phone:
Email:
  Business Address
Address:
 
City:
State:
Postal Code:
Phone:
Email:
  Current Students
Please Complete the Following
School Name:
School Address:
 
City:
State:
Postal Code:
School Phone:
School Email:
  Additional Information
Date of Birth:
Names and Ages of Dependents:
Profession (include degrees and certifications):
Current Status: In School (Year):
Resident:
Practicing:
Anticipated Field of Service:
Anticipated date of departure for the mission field:
Name of Mission Board:
Anticipated Total Amount of Student Loans:
Interest Rates, Date Payment Begins:
What is the earliest date by which you could finish repayment and be free to serve if you receive no help?

Have you had prior experience on the mission field (either long- or short-term)? Explain. 

 
Would you be willing to send a semiannual report to the organization or individual who would provide debt repayment for you while you serve?

Yes  No

Remarks directed to a funding agency or individual donor.  Major donors are interested in issues such as the urgency of your arrival on the mission field, your relationship to evangelism and church planting, literature distribution, etc. and the significance of the student loan barrier as it affects your release to the field.
 

I agree / do not agree to allow Project MedSend to use this information to solicit gifts and grants when donors ask for specific instances of need for debt repayment.

After completing this questionnaire, please send a prayer card with your family or individual picture and mail at your earliest convenience, to Project MedSend, P.O. Box 1098, Orange, CT 06477.

Please print this page for your own records.

       

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