ࡱ> KMJq  bjbjt+t+ *FAA =]BBBBBBBVVVV8L4V*F\\\\t$@B8 \\8 8 @p BB\\*p p p 8 B\B\VVBBBB8 p p BB\OVVN "  DATE \@ "d-MMM-yy" \* MERGEFORMAT 8-Jun-07 This form may be printed out or completed online and printed out Volunteer Information: Name:  FORMTEXT       Address:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       Date of Birth:  FORMTEXT       Marital Status:  FORMDROPDOWN  Contact Person while overseas (i.e. spouse, next of kin, friend) Name:  FORMTEXT       Relationship:  FORMTEXT       Address:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       To be filled out by volunteer Are you aware that ICMI is mandated to engage in teaching and training programs, and not in humanitarian or service projects? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Do you have questions about this?  FORMTEXT       What specific skills would you like to offer?  FORMTEXT       Academic qualifications (degrees completed or in progress):  FORMTEXT       Express your views about what you hope to give and learn from this experience.  FORMTEXT       Health concerns  FORMTEXT       Are you free of any impediments to international travel?  FORMTEXT       Will you be able to assume the financial responsibility for this volunteer assignment?  FORMTEXT       If your application is accepted you will need to become a member of ICMI, paying either the student or full membership fee. You will also need to sign a waiver of responsibility. Agree  FORMCHECKBOX  Disagree  FORMCHECKBOX  Any research or professional papers arising from your involvement in this volunteer assignment must give appropriate credit to ICMI. Agree  FORMCHECKBOX  Disagree  FORMCHECKBOX  Please give two or three references. (e.g. professional, personal, church) Name:  FORMTEXT       Address:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       Relationship:  FORMTEXT       Name:  FORMTEXT       Address:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       Relationship:  FORMTEXT       Name:  FORMTEXT       Address:  FORMTEXT       Phone:  FORMTEXT       Fax:  FORMTEXT       Email:  FORMTEXT       Relationship:  FORMTEXT       Statement of Faith Our Statement of Faith is:  Believing the Bible to be the Word of God, we endeavor to follow Christ s command in Luke 10:27  You shall love the Lord your God with all your heart, and with all your soul, and with all your strength, and with all your mind, and your neighbor as yourself. Accepting therefore the Lordship of Jesus Christ, we attempt to follow His example of compassion and healing toward the suffering and oppressed, and to embrace His concern for the whole person. Our Christian faith is evangelical, transdenominational, and practical. Are you prepared to operate as a team member in cooperation with this mandate? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Please sign below if you have read, understood, and agree with all the above requirements. 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