Mentor Leaders

I understand I am applying for the Mentor Leaders mission trip to Haiti in June 2022

I understand

First name

Last name

Nick name

Email

Phone

Address

City

State

Zip Code

Date of Birth (dd/mm/yyyy)

Gender

Female Male

Marital Status

Not Married Married

Church Home

Pastor's First & Last name

Is this your first time traveling with Mentor Leaders?

No Yes

Do you currently sponsor a child with Mentor Leaders?

No No, but I want to learn more! Yes

Personal Bio - Tell us about your spiritual journey! Where are you today and how did you get there? If you've traveled with us before, please provide us an update.

Talents and Skills - Please tell us about the talents and skills you hope to utilize on the trip.

Spiritual Leader / Pastor Reference - First & Last Name, Phone Number

Spiritual Leader / Pastor Reference - Email

Personal Reference - First & Last Name, Phone Number - No family members

Personal Reference - Email

By signing below you agree and understand that all gifts, whether by yourself or others, that are made to Mentor Leaders are non-refundable.

I agree

All gifts will be considered a preference gift for your trip which is subject to the sole discretion and control of Mentor Leaders.

I agree

Mentor Leaders has staff in place to oversee and manage these gifts so that travelers do not need to account for gifts.

All the information I have given is true and correct.

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X - 2022 - Haiti - Application

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