DA NANG, VIETNAM

HUMANITARIAN TEAM APPLICATION

September 18 – October 3, 2008

 

Please provide all information requested. Return pages 1-4 as soon as possible. Keep pages 5-7.  Include appropriate trip payments to bring you up to date per the “Schedule of Trip Payments.

 

PERSONAL INFO

 

FULL NAME: ___________________________________ NICKNAME: ________________

 

STREET ADDRESS: _________________________________________________________

 

CITY: ________________________ STATE: _________ ZIPCODE: __________________

 

HOME TELEPHONE: _______________ HOME EMAIL: _________________________

 

WORK TELEPHONE: _______________ WORK EMAIL: _________________________

 

IN CASE OF EMERGENCY CONTACT: _______________________________________

 

 

VITAL STATISTICS

 

HEIGHT: _____ WEIGHT: _____ AGE: _____ MARITAL STATUS: ________________

 

SS #: ____ - ___- _____ DRIVER’S LICENSE NUMBER & STATE: ________________

 

CITIZENSHIP: __________________ DO YOU HAVE A PASSPORT? Y (  )  N (  ) 

 

IF YES, PASSPORT #:____________________EXPIRATION DATE: ______________

 

Do you have a criminal record? Yes (  )  No (  ). If yes, you will be asked to discuss the circumstances surrounding your criminal record before a decision can be made on your participation on this humanitarian team.

 

ARE YOU A SMOKER? YES (  )  NO (  )   DO YOU SNORE?  YES (  )  NO (  ). THIS INFO IS REQUESTED FOR ROOMMATE ASSIGNMENT.

 

 

 

 

PREVIOUS VIETNAM EXPERIENCE

 

DID YOU SERVE DURING THE VIETNAM WAR?  Y (  )  N (  ) IF YES, PLEASE PROVIDE THE FOLOWING INFORMATION:

 

CIVILIAN (  ) OR MILITARY (  ).  DATE IN COUNTRY: ___________ to ___________

 

IF CIVILIAN, WHAT WAS YOUR JOB? ________________________________________

 

______________________________________________________________________________

 

______________________________________________________________________________

 

IF MILITARY, WHAT WAS YOUR JOB/MOS? _________________________________

 

______________________________________________________________________________

 

BRANCH OF SERVICE: _________________ UNIT: ____________________________

 

RANK OR GRADE: __________________ HONORABLY DISCHARGED? Y (  ) N (  )

 

DID YOU SERVE IN SOUTH VIETNAM (  )   THAILAND (  )  OFF THE COAST OF NORTH OR SOUTH VIETNAM? (  )  GUAM  (  ) Cambodia (  ) OR ELSEWHERE? (  )  LOCATION: ____________________________________________________________________________

 

PLEASE FORWARD A COPY OF YOUR DD214 AND/OR DD215.

 

This is required all veterans to participate on the team!

 

MEMORANDUM OF UNDERSTANDING

 

Do you understand that the primary purpose of “VETS WITH A MISSION” is to promote reconciliation in keeping with II Corinthians 5:18? VWAM is a Christian founded organization by Vietnam veterans and desires to be a Christian witness in conduct and character. We are asking you to represent the United States of America in the highest ideals of service and charity, to present yourself at all times as a goodwill ambassador, to create an atmosphere of trust and cooperation in the performance of humanitarian work in Southeast Asia primarily in Vietnam, Cambodia and/or Laos; and to promote positive working relationships with other organizations and NGO’s, to assist VWAM in remaining faithful to the Great Commission given in Matthew 28:18-20, and to further the healing process between the veterans of all countries involved in the war, the people of the United States of America, and the peoples of Vietnam, Cambodia, and Laos?                      

 

Yes (  ) No (   )

 

Do you understand that the purpose of this trip is to promote reconciliation and conduct humanitarian work in sharing the love of Jesus Christ through word, action and deed? As a member of this team you are expected through your participation to honor and complement the honorable service of those who served and, furthermore, do you understand that you are going in a non-political capacity which will require that you avoid politically sensitive subjects such as POW’s, MIA’s, criticism of the communist government, or controversial discussions about the US involvement in the Vietnam War with Vietnamese?  Even though all of us have deep personal convictions about these and other issues it is very important that you do not jeopardize the long-term commitment and objectives of VWAM’s call to Southeast Asia with inappropriate remarks, comments or discussions?

 

Yes (  ) No (  )

 

Are you willing to submit yourself to the oversight and leadership of the VWAM and its Team Leader(s), and to work within the framework of cooperation to maintain a spirit of unity and teamwork at all times?

 

Yes (  ) No (  )

 

Do you understand that the use of illegal drugs, abuse of alcohol, inappropriate sexual-physical behavior, violation of any Vietnamese law, and purposeful non-adherence to the tenets listed above will result in the revocation of your Vietnamese Entry Visa and immediate expulsion from the country without any refund of monies paid?

 

Yes (  ) No (  )  

 

Do you speak any Vietnamese or French? _______________ If so, how fluent are you in this language? ____________________________________________________

 

______________________________________________________________________________

 

Any additional comments that you would like to make related to your participation on this team/trip: ______________________________________________________________________

 ______________________________________________________________________________

_____________________________________________________________________________.

 

WILL YOU RETURN TO THE UNITED STATES WITH THE TEAM OR DO YOU PLAN TO REMAIN IN VIETNAM, CAMBODIA, LAOS OR THAILAND TO TOUR?

 

Please indicate Y (  )  N (  ).

 

If you checked Y (  ) VWAM will place you in contact with our travel agent to make those arrangements. Remember, your visa is valid for thirty (30) days from the time you enter the country.

 

Any additional information or comments you deem important for Vets With A Mission to have: