Chi Alpha at University of Central Florida

First Name (as it appears on your government-issued ID)

Middle Name (as it appears on your government-issued ID)

Last Name (as it appears on your government-issued ID)

Address

Country

City

State

Zip/Postal Code

Email Address

Phone Number

Birthdate (MM/DD/YYYY)

I am a:
Male
Female

School
UCF
Valencia College
Another university/college
I'm not a student

Are you an international student?
Yes
No

Allergies, Health Concerns, or Dietary Restrictions?

I need special accommodations:
Handicap Accessibility
Spanish-English Translation
Sign Language Translation
Other Accommodations
I don't need special accommodations

Full Name of your Emergency Contact

Emergency Contact Relationship to You

Phone Number of your Emergency Contact

Tell us about when you accepted Jesus.

What is your experience, if any, with water baptism? (Water baptism is not required for participation on this trip.)

Tell us about any mission trip experience you have had.

How do you hope to grow on this mission trip?

Let us know what questions or concerns you have.

I understand that our 5 available spots are FIRST COME FIRST SERVE for UCF students but are also pending the staff’s review of your application responses. I understand I will hear back from XA at UCF staff by November 18th. Upon acceptance onto the team, I understand I must submit my $30 deposit on November 20th to reserve my spot. I understand all payments are non-refundable.
I understand

I understand I will be responsible for meeting the following financial deadlines: $30 deposit by November 20th, $100 by December 15th, $100 by January 15th, and $100 by February 1st. I understand an inability to meet these deadlines could compromise my involvement on this mission trip.
I understand

I understand payments for this mission trip can be submitted via the XA at UCF app, xaatucf.com/give, or via check to Chi Alpha at UCF. I understand all payments must designate this trip as the fund recipient and must notate my full name as the honoree. I understand all payments are non-refundable.
I understand

I personally assume all health risks including but not limited to COVID-19.
I agree

I have read through the Mission Trip Team Covenant attached below and I agree to the Mission Trip Team Covenant, understanding that major deviations from the covenant can result in the termination of my participation on this mission trip.
I agree

A P P L Y H E R E

University of South Florida Mission Trip

March 16 - March 23 in Tampa, FL
$330 per person

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