Application

Type of Missionary service for which you are applying*
- Team
- Individual
- Both
Country or Place of Interest*
Date or projected date of Bible College Graduation*
Marital Status*
- Single
- Married
- Engaged

General Information
Name*
Prefix First Middle Last
SSN*
Birthday*
Country of Citizenship*
Spouse's Name
Prefix First Middle Last
SSN
Country of Citizenship
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Names of Children
Name Birthday

Current Church Membership
Church Name*
Church Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Church Phone*
Pastor's Name*
Prefix First Last Suffix
Have you been ordained:*
- Yes
- No
Please indicate church and date:*
Church Date

Education History
High School*
Graduated?
Colleges and/or other training:
Please indicate all education beyond High School
Institution Graduated?
Other Special Training

Employment History
List present and previous employers:*
Present or most recent employer first
Name of Employer Dates Employed Type of Employment Supervisor's Full Name Phone Number

Christian History
Approximate date of your salvation:*
Approximate date of your baptism:*
Relate briefly the testimony of your salvation:*
Describe your daily walk with God*
Include a description of your devotional life
Explain your call to full-time Christian service:*
In what Christian service are you and have you been involved:*
i.e. bus ministry, nursing home ministry, Sunday School classes, etc. Please include length of time involved
Ministry Length of time
When did you lead your last soul to Christ:*
How many souls have you led to Christ in the last 30 days:*
Briefly give one or two examples of someone that you have led to Christ including their names:*
How many converts have you seen baptized in the last 30 days:*
Briefly give one or two examples of someone that you have helped lead to spiritual maturity:*

Personal Call to Missions
Explain why you sense God's call to missionary service:*
Is there a specific type of ministry you feel called to do?*
What do you believe is the purpose of a missionary?*
What do you believe is the purpose of a church?*
Have you ever applied for or served with another missions agency?*
- Yes
- No
Please give the name of the Agency, and explain why you are no longer affillated with them.*
Does your pastor recognize and support God's call in your life to the mission field:*
Does your church support your applying to FBMI:

Personal Convictions
What does it mean to you to be a Baptist:*
What do you consider to be core doctrines of the Faith:*
What are your convictions regarding the KJV:*
What do you believe are Biblical guidlines for modesty:

Personal References
Please give names and contact information of four references in the following order:
Your sending church Pastor:
Name
First Last
Phone
Email
Another pastor whom you know:
Name*
Prefix First Last
Phone*
Email*
A ministry leader with whom you've served:
Name*
Prefix First Last
Phone*
Email*
A faculty member from Bible College:
Name*
Prefix First Last
Phone*
Email*

Financial Information
Having an accurate account of your general financial standing is an important step in applying with FBMI. Please answer the following questions as accurately as possible.
Do you currently have any outstanding financial debt:*
- Yes
- No
What is the specific nature of the debt:*
Credit card, mortgage, etc.
What are your current plans to pay off the debt:*

Health Information
This next section is a health history questionnaire which must be completed carefully in detail, answering all questions for both you and your spouse. The questionnaire is reviewed by our Medical Advisor before acceptance by FBMI. Records are kept in the strictest confidence and will not be released to unauthorized persons.

Your Health Section
General Information
Name
Prefix First Last
Age
Type of work you expect to do on the field:
When do you expect to go on the field:
Your birthplace:
Principle nationality of your father:
Principle nationality of your mother:
States or countries where you have resided:
Indicate if urban, rural, farm, etc. as well as dates lived there
Where Urban, Rural, etc Dates
Were you ever rejected for military service:
- Yes
- No
Please give explanation
Were you ever in the Armed Forces:
- Yes
- No
List
Unit Dates Where
Type of Discharge
Any service injury or disability:
- Yes
- No
Nature of injury or disability
Receiving compensation?
Describe your present health in your own words:

Insurance and Institutional Information
Have you ever applied for disability or unemplyement compensaion
If so, please indicate which
What physical weak point do you feel might handicap you in missionary work
Have you ever been denied insurance on health basis
What hospitalization insurance do you have?
Any know deformaties or birthmarks?
List the main reasons for hospitalizations, doctor's visits, or serious accidents in the last three years:

Health Information
Physical Characteristics
Height
Weight
Last year weight gain or loss:
Maximum Weight When
Color of hair
Color of eyes
Identifying marks
Right or Left Handed:
Blood Pressure
Habits
How much coffee do you drink daily
How much tea do you drink daily
What medicines are you currently taking on a regular basis
Do you eat breakfast regularly:
Describe an average breakfast:
Describe an average lunch:
Describe an average evening meal:
Have you ever followed any special type of diet
- Yes
- No
Please describe the diet:
How much sleep do you average per night:
What is your usual bedtime:
List any sleep problems
What is your usual hour of arising
Do you fall asleep quickly
- Yes
- No
Do you use any sedatives
- Yes
- No
Specify:
Do you participate in any sports

Family History
Please indicate below with each of your direct family members: Father, mother, and any brothers, sisters, children whether or not they are living, their current age/age at death and any diseases that they did or their cause of death
Relation Living Age Disease/Cause of death
Father
Is he living?
- Yes
- No
Cause of Death
Age
Any diseases?
Mother
Is she living?
- Yes
- No
Cause of Death
Has any blood relation (parent, brother, sister, etc.) or spouse had:
Tuberculosis
- Yes
- No
How related?
Syphillis
- Yes
- No
How related?
Diabetes
- Yes
- No
How related?
Kidney Trouble
- Yes
- No
How related?
Cancer
- Yes
- No
How related?
Heart Trouble
- Yes
- No
How related?
Arteriosclerosis
- Yes
- No
How related?
Disease of nervous system
- Yes
- No
How related?
Rheumatism (arthritis)
- Yes
- No
How related?
Stomach trouble
- Yes
- No
How related?
Asthma
- Yes
- No
How related?
Epilepsy
- Yes
- No
How related?
Mental Problems
- Yes
- No
How related?
Committend Suicide
- Yes
- No
How related?

Rate yourself on a scale of 1-5 in regard to the following characteristics, 5 being the highest
Nervous - Tense, high-strung, apprehensive
Composed - Calm, relaxed, tranquil
Depressive - Pessimistic, discouraged, dejected
Light-hearted - Happy, cheerful, optimistic
Active/Social - Energetic, enthusiastic, socially involved
Quiet - Socially inactive, lethargic, withdrawn
Expressive/Responsive - Spontaneous, affectionate, demonstrative
Inhibited - Restrained, unresponsive, repressed
Sympathetic - Kind, understanding, compassionate
Indifferent - Unsympathetic, insensitive, unfeeling
Subjective - Emotional, illogical, selfabsorbed
Objective – fair-minded, reasonable, logical
Dominant – Confident, assertive, competitive
Submissive – Passive, compliant, dependent
Hostile – Critical, argumentative, punitive
Tolerant – Accepting, patient, humane
Self-disciplined – Controlled, methodical, persevering
Impulsive – Uncontrolled, disorganized, changeable
If married, how do you rate your relationship to your spouse?
If you have children, how do you rate your relationship with your children?
How do you rate your relationship to your parents?
If unmarried, how do you rate your relationship to your family?
How would your rate your relationship with other close associates?

Surgery
Please indicate if you currently or have ever had:
- Tumor, growth, cyst
- Cancer
- Rupture
- Appendicitis
- Skin mole removed
- Goiter
Comments on anything above:
Please list any operations you have had or have been advised to have:
Operation Doctor and address Why advised Date
Please list any hospitalizations you have had or have been advised to have:
Hospital Doctor and address Why advised Date
Please list any accidents or serious injuries you have had:
Accident/injury Date

Miscellaneous
Have you ever had:
Physiotheraphy or heat treatments
- Yes
- No
Reason Practitioner Date
Chiropractic adjustments
- Yes
- No
Reason Practitioner Date
Colonic irrigations
- Yes
- No
Reason Practitioner Date
Naturopathic treatments
- Yes
- No
Reason Practitioner Date
Foot treatments
- Yes
- No
Reason Practitioner Date
Other Special treatments
- Yes
- No
Reason Practitioner Date
Have you ever had any illness or injury other than those already noted?
- Yes
- No
Explain:
Have you consulted or been treated by clinics, physicians, healers, or other practitioners within the last five years?
- Yes
- No
Explain:
Have you ever had an undiagnosed weakness, chills, and/or fever?
- Yes
- No
Explain:
Have you ever had rapid weight gain or loss?
- Yes
- No
Explain:

Spouse's Health Information
General Information

Autobiographical Sketch
Stressful situations are met on any mission field with respect to coworkers and the indigenous peoples. Emotional maturity and social compatibility are required. For this reason, a resume of your background and relationship to family and friends is requested in this evaluation. Please write an autobiography in essay style, using appropriate paragraphs, treating in detail the subjects indicated. The outline which follows is only a guide and is not to be copied or answered in question and answer fashion. Use as many sheets as required, with your name and page number on each. A. FAMILY BACKGROUND 1. Your birthplace, home, and parents: Were your parents compatible, happy, or the converse? List the children born to your parents in order of birth. Were you raised in a Christian home? 2. Mention others who lived in the same household for any time during your growing-up period, i.e. relatives, boarders, hired hand, housekeeper, servants, etc. Mention, if appropriate, foster parent, step-parent, divorce, etc. FATHER 1. His occupation and work habits during your childhood 2. His personality and habits in relationships with people 3. Your personal relationship with him and any significant changes in it as you matured MOTHER 1. Her occupation, if she worked for long periods during your childhood 2. Her work at home, amounts of responsibility she took for the work and management of the household 3. Her personality and habits in relationships with people 4. Your personal relationship with her and any significant changes in it as you matured BROTHERS AND SISTERS 1. Describe your relation with each. Indicate if you were an “auxiliary parent” to a younger child or, conversely, if you were in the place of a younger child supervised by an older one. 2. Were there feelings of unusual intensity, positive or negative, with any brother or sister? 3. What was the general atmosphere? Were there jealousies,tensions? Was it a close-knit family or rather on the remote,self-sufficient side? What did you do together (church, games, sports, travel)? 4. Describe present occupation and current age of each brother or sister, marital status, religious affiliation, and present family group. B. SCHOOL 1. Where did you attend grade school, high school? describe briefly two or three events from elementary school. 2. Did you have trouble with teachers? Why? or Why not? 3. High school: favorite subjects; extracurricular activities: school paper, clubs, sports, etc. Did you ever quit school? If so, why? 4. College: relationships with roommates, if any. Did you change majors? Why? In what ways did you mature? C. SOCIAL 1. Clubs, Scouts, 4-H (outside of school), hobbies, church 2. Dating: Review briefly. Attitude toward marriage, children. (See also on E.) D. PERSONAL 1. Are you aware of any extreme likes or dislikes or special fears which have disturbed you in the past? 2. What do you consider your strong points? Weak points? 3. Any lack of emotional control? How do you explain it? 4. Are you unusually sensitive? Have you lost your temper at someone in the last few months? 5. Is sustained concentration difficult? List the books that you have read in their entirety in the last six months. 6. Was there a time of rebellion in your teen or later years? 7. Are you subject to faintness or dizziness? Great fatigue? Prolonged depression? 8. Have you ever had a “nervous breakdown”? Describe. 9. Have you ever sought consultation with a neurologist, psychiatrist, or a psychologist? 10. Describe an instance of relying on spiritual help in time of discouragement. 11. Have you ever tried to offer counsel to someone else in trouble?Describe a case. 12. How often do you have personal, private devotions (time spent, materials used)? Family prayers? 13. Is your spiritual, social, intellectual, and emotional growth basically satisfactory to you? Why or why not? E. MARRIAGE Date of marriage, courtship. Were both Christians at time of marriage? Additional remarks. F. GROUP RELATIONSHIPS 1. Give the name and address of one employer for whom you worked for at least six months who has a personal acquaintance with you and has observed your relationships with your co-workers. 2. Give name and address of one group leader who has observed you for a period of six months in your relationship with the group (Explorers, AWANA, scouts, etc.) working on definite projects together, preferably a group in which you were active beyond the age of sixteen.

FBMI Application

Step 1 of 23

General Information

Current Church Membership

Education History

Employment History

Christian History

Personal Call to Missions

Personal Convictions

Personal References

Your sending church Pastor:

Another pastor whom you know:

A ministry leader with whom you've served:

A faculty member from Bible College:

Personal Information

Financial Information

Health Information

Your Health Section

General Information

Occupational Information

Have you been unable to hold a job because of:

Insurance and Institutional Information

Health Information

Physical Characteristics

Habits

Family History

Has any blood relation (parent, brother, sister, etc.) or spouse had:

Past Medical History

Rate yourself on a scale of 1-5 in regard to the following characteristics, 5 being the highest

Surgery

Miscellaneous

Have you ever had:

Spouse's Health Information

General Information

Autobiographical Sketch

MISSIONARIES

Name	Birthday

Institution	Graduated?

Name of Employer	Dates Employed	Type of Employment	Supervisor's Full Name	Phone Number

Ministry	Length of time