First and Last Name:
Mailing Address:
Mailing Address:
City, State, Zip Code:
E-Mail Address:
Telephone Number:
Date of Birth:
Gender: Male Female
Are you a United States citizen? Yes No
If you are not a U.S. citizen, what country are you a citizen of?
Current Marital Status: Married Single Engaged Widowed Seperated Divorced
Have you ever been: Married Divorced Seperated Widowed
Do you have any children? Yes No
List names and ages of your children:
What is your current occupation?
How would you describe your current health? Excellent Good Fair Poor Bad
Briefly describe any health problems you may have:
Date of last medical checkup:
What education have you completed?
Describe any special training or skills you have:
Are you currently attending a church? Yes No
Name, address, telephone number of your church:
Describe your current church activity:
Describe when and how you accepted Jesus Christ as your Savior?
Describe how you learned of VFCM:
Indicate your interest level in joining VFCM: Volunteer Work Team Full-time Missionary