STUDENT MINISTRY TRIP APPLICATION

DAYTON CHRISTIAN SCHOOL SYSTEM R 10/07

For Office Use

Date of submission_________Reference Forms Parent __Pastor__Teacher__Friend__
Passport Information: Current ____ Application ____

Name ________________________________ Campus ____________________ Grade ___

Address ______________________________ City_______________________ Zip ______
Home Phone Number ____________________Cell Phone Number ______________________
Trip Destination ____________________ Student’s E-mail Address _____________________
Date of Trip _____________________ Parent’s E-mail Address________________________

Church _____________________________ Phone Number _______________________

Address _______________________________ City ___________________ Zip ______

1. Have you previously been on a mission/ministry trip? ____Was it a DCSS trip? ______
When?________ Where? ________________ Who was the leader? _____________

2. Why do you want to go on this ministry trip? What have you heard about this trip?

3. If you have been on a previous trip to this same destination, why do you want to go again?

4. Name one thing God has taught you in the last few months. Explain how.

5. What things do you hope to accomplish in your own life by participating in this ministry trip?

6. How have you been serving the Lord here at home? Explain how.
7. Why do you think God wants you on this trip?

8. What specific skills/talents has God given you that you could use on this trip?

9. Do you have any fears or apprehensions about this trip?

10. Do you believe you can raise the necessary funds? How do you plan to do this?

11. Will you be available to attend the Discipleship/Training meetings?

12. Are you responsible and obedient to those in authority? Please give an example.

13. If you are applying for a J-Term trip have you checked to make sure that you are not missing a
required course necessary for graduation? □ Yes □ No

14. Please attach either a completed but UNSIGNED copy of your passport application or a copy of
your current passport.

*Parent signature signifies that you give permission for your child to be considered for a mission
trip. Please know that seniors are not automatically accepted and that seldom are dating couples
both accepted.

________________________________ ___________________________ _________

Parent’s Name Parent’s Signature Date

Please have Reference Forms from the following persons sent to the Ministry Director:

1. Must have a… Parent Reference submitted with your application

2. Must have a … Pastor or Youth Pastor from your church
3. Must have a… Teacher who knows you pretty well
4. Must have an… Adult Friend who knows you well from church, a supervisor at work,
or family friend.
 STUDENT MINISTRY TRIP REFERENCE FORM
DAYTON CHRISTIAN SCHOOLS, INC. 11/01
Parent

I, ____________________________ have applied to participate in a Ministry Trip

(student’s name)
sponsored by Dayton Christian School System.

Trip applying for is: _______________________________________________________

Applicant’s signature: ______________________________________ Date___________

What is your observation of your child in the following areas:

Academic Performance: ______________________________________________

__________________________________________________________________
Social Adjustment: __________________________________________________
__________________________________________________________________
Emotional Adjustment: ______________________________________________
__________________________________________________________________
Christian Character and Commitment: __________________________________
__________________________________________________________________

How would your child benefit the Ministry Team? _______________________________

________________________________________________________________________

List other strengths your child has: ___________________________________________

________________________________________________________________________

List any weaknesses your child has: ___________________________________________

________________________________________________________________________

How would your child benefit from participating in this ministry trip? _______________
________________________________________________________________________

Will this trip prevent your child from participating in a church-sponsored trip? Y or N

___________________________ _____________________________ __________

(Your name - printed) (Your signature) (Date)

*This form must be submitted with the application.

 STUDENT MINISTRY TRIP REFERENCE FORM
DAYTON CHRISTIAN SCHOOLS, INC. 11/06
Pastor

I, ____________________________ have applied to participate in a Ministry Trip

(student’s name)
sponsored by Dayton Christian School System.

Trip applying for is: _________________________________________________

I would like you, _____________________________ to answer the following questions

(Name filling out form)
about me and send to the Ministry Trips Director at Dayton Christian School System.

Waiver of right of access to confidential statement: I, the undersigned, hereby voluntarily waive any
right to inspect the content of this letter of recommendation.

Applicant’s signature: ______________________________________ Date___________

How long have you known this student?________________________

What is your observation of the student in the following areas:

Academic Performance: _____________________________________________

_________________________________________________________________

Social Adjustment: _________________________________________________

_________________________________________________________________

Emotional Adjustment: ______________________________________________

_________________________________________________________________

Christian Character and Commitment: __________________________________

__________________________________________________________________

How would this student benefit the Ministry Team? ______________________________

________________________________________________________________________
List other strengths the student has: ___________________________________________
________________________________________________________________________

List any weaknesses the student has: __________________________________________

_______________________________________________________________________

Please check one:

____ I highly recommend this student

____ I recommend this student

____ I recommend this student with some reservations

____ I do not recommend this student

_____________________________________ ______________________________
(Your name - printed) (Your title/position)

_____________________________________ ______________________________
(Your signature) (Date)

_______________________________________ ______________________________
(Your telephone number at home and/or at work) (Email Address)

Send to: Nancy Snook

Ministry Trips Director
9391 Washington Church Rd.
Miamisburg, OH 45342

*Student will provide envelope and stamp.

Or you may put this form in (sealed envelope) the Ministry Trips Director’s box, or use campus
mail. Thanks for your support, prayer, and encouragement.
 STUDENT MINISTRY TRIP REFERENCE FORM
DAYTON CHRISTIAN SCHOOL SYSTEM 11/06
Teacher

I, ____________________________ have applied to participate in a Ministry Trip

(student’s name)
sponsored by Dayton Christian School System.

Trip applying for is: _________________________________________________

I would like you, _____________________________ to answer the following questions

(Name filling out form)
about me and send to the Ministry Trips Director at Dayton Christian School System.

Waiver of right of access to confidential statement: I, the undersigned, hereby voluntarily waive any
right to inspect the content of this letter of recommendation.

Applicant’s signature: ______________________________________ Date___________

How long have you known this student?________________________

What is your observation of the student in the following areas:

Academic Performance: _____________________________________________

_________________________________________________________________

Social Adjustment: _________________________________________________

_________________________________________________________________

Emotional Adjustment: ______________________________________________

_________________________________________________________________

Christian Character and Commitment: __________________________________

__________________________________________________________________

How would this student benefit the Ministry Team? ______________________________

________________________________________________________________________
List other strengths the student has: ___________________________________________
________________________________________________________________________

List any weaknesses the student has: __________________________________________

_______________________________________________________________________

Please check one:

____ I highly recommend this student

____ I recommend this student

____ I recommend this student with some reservations

____ I do not recommend this student

_____________________________________ ______________________________
(Your name - printed) (Your title/position)

_____________________________________ ______________________________
(Your signature) (Date)

_______________________________________ ______________________________
(Your telephone number at home and/or at work) (Email Address)

Send to: Nancy Snook

Ministry Trips Director
9391 Washington Church Rd.
Miamisburg, OH 45342

*Student will provide envelope and stamp.

Or you may put this form in (sealed envelope) the Ministry Trips Director’s box, or use campus
mail. Thanks for your support, prayer, and encouragement.
 STUDENT MINISTRY TRIP REFERENCE FORM
DAYTON CHRISTIAN SCHOOLS, INC. 11/06
Adult Friend

I, ____________________________ have applied to participate in a Ministry Trip

(student’s name)
sponsored by Dayton Christian School System.

Trip applying for is: _________________________________________________

I would like you, _____________________________ to answer the following questions

(Name filling out form)
about me and send to the Ministry Trips Director at Dayton Christian School System.

Waiver of right of access to confidential statement: I, the undersigned, hereby voluntarily waive any
right to inspect the content of this letter of recommendation.

Applicant’s signature: ______________________________________ Date___________

How long have you known this student?________________________

What is your observation of the student in the following areas:

Academic Performance: _____________________________________________

_________________________________________________________________

Social Adjustment: _________________________________________________

_________________________________________________________________

Emotional Adjustment: ______________________________________________

_________________________________________________________________

Christian Character and Commitment: __________________________________

__________________________________________________________________

How would this student benefit the Ministry Team? ______________________________

________________________________________________________________________
List other strengths the student has: ___________________________________________
________________________________________________________________________

List any weaknesses the student has: __________________________________________

_______________________________________________________________________

Please check one:

____ I highly recommend this student

____ I recommend this student

____ I recommend this student with some reservations

____ I do not recommend this student

_____________________________________ ______________________________
(Your name - printed) (Your title/position)

_____________________________________ ______________________________
(Your signature) (Date)

_______________________________________ ______________________________
(Your telephone number at home and/or at work) (Email Address)

Send to: Nancy Snook

Ministry Trips Director
9391 Washington Church Rd.
Miamisburg, OH 45342

*Student will provide envelope and stamp.

Or you may put this form in (sealed envelope) the Ministry Trips Director’s box, or use campus
mail. Thanks for your support, prayer, and encouragement.