Apply Online

To apply, please use our Printable Application or fill the on-line form below.

In addition to application below, please also send us the following:

_____ Recent photo. (Optional - Will not be returned)
_____ $100.00 deposit - at your request this is transferable to another project, but it is not refundable.
          The remainder of the project donation is due one month before the beginning of the Project.
_____ Medical/Dental professionals must send a copy of their diploma and current professional license.
_____ All physicians please send a Curriculum Vitae and current list of surgical privileges, if applicable.
_____ All applicants must sign and submit a liability release for IMA.
          Please print this form, sign it and mail it to us. Liability Release Form

Project Name
Project Dates
If two-week project, please indicate first week, second week, or both	one week   two weeks    both weeks
Project Type	one week   two weeks
Name of Applicant
Home Address
City, State, ZIP
Home Phone
Work Phone
Cell Phone
Fax
E-mail Address (important!)
Social Security #
Gender	Male   Female
Birth Date
Passport Number
Name on passport
Citizenship
Nickname/Preferred Name
Marital Status
If married, spouse's name
Medical Specialty
Board Qualifications
Nursing Degree/Title
Years of experience
Area of interest
Student	Medicine   Dentistry   Nursing   Other:
Emergency contact: name
Emergency contact: address
Emergency contact: City, State, ZIP
Emergency contact: phone
Emergency contact: relationship
Are you part of a group applying for this project?	Yes   No
If yes, which group?
Do you speak Spanish?	Yes   No
How many years of Spanish have you taken in school?	High School   College
Are you proficient enough to interpret?	Yes   No
Are you coming as a General Helper?	Yes   No
Special Skills/Talents
Are you taking medication that will affect your ability to work with the medical team?	Yes   No If yes, please explain:
Are you disabled or limited in normal activities?	Yes   No
If so, explain
Do you have dietary restrictions that we must plan for?
Is this the first time you attend a mission trip with IMA?	Yes   No
Other missionary experience?	Yes   No If yes, please explain:
Morning Devotions: Would you like to prepare a 5-10 min devotional for the team?	Yes   No
How did you hear about IMA?	Family/Friends   IMA Website  Church   Conference Publication   other:
SUGGESTED DONATION	Personal Check made payable to IMA Donation Through Paypal
Your Name

If you would like to make a donation through paypal, click on the image below.

Please print the application for your own records.
Please print, sign and submit (by mail, fax, or scan an e-mail) a Release of Claims Form.