Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Phone *

(###)

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Church's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Role at Church *

What role(s) do you play at your church? (Check all that apply)

Elder

Missions Staff

Other Church Staff

Missions Team/Committee

Ministry Longevity *

If you are on staff or other leadership role, how long have you been so?

1-2 years

3-5 years

6-9 years

10-15 years

15+ years

Frequency of Availability *

Please indicate how many Friday-Saturday Envision onsites you anticipate being able to facilitate in a 12-month period:

2-3

4-6

7-9

10+

Focus *

Areas in which you have experience and capability to assist other churches (check all that apply):

Missions Vision & Strategy

Caring for Global Workers 

Short-Term Trips

Engaging Internationals (refugees, international students, immigrants)

Name of Reference *

Please name a reference we can contact for an under-ten-minute conversation:

First Name

Last Name

Reference Phone

(###)

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