South America Mission | Preliminary Information Form

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Preliminary Information Form

The Preliminary Information Form is one step in your relationship with South America Mission. It is not considered an application, and does not obligate you to become a member of SAM. The information you give will help us on the SAM staff to get to know you better in order that we can provide whatever information or counsel is suitable for your situation. Husbands and wives, please fill out separate forms. Please enter twice after each paragraph.

Name...

Prefix:

First:

Middle:

Last:

Contact Information...

Email:

Street:

City:

State:

Country:

Zip/Postal Code:

Phone:

Current Address (if different from above)

Street:

City:

State:

Country:

Zip/Postal Code:

Phone:

Other contact information

Place of Employment:

Work Phone:

Other information about you...

Citizenship:

Date of Birth:

MM/DD/YYYY

Marital Status:

Date Married (if married):

MM/DD/YYYY

Name of Spouse (if married):

Names and ages of children:

Complete the following education history section beginning with high school and ending with highest form of education:

What other languages do you speak?

How well?

Information about your spiritual life...

Briefly state the time and circumstances of your conversion and your subsequent spiritual development:

Current Church Information

Church Name:

Address:

Phone:

Number of years attended:

Pastor name:

Home Church Information (if different from above)

Church Name:

Address:

Phone:

Number of years attended:

Pastor name:

Areas of Service

Briefly describe what area of ministry you are involved in or one you have been involved in:

What has led you to pursue missionary service?

In what field and/or type of ministry are you interested?

How did you learn about SAM?

Term of service:

Please check one of the following statements to indicate your present position:

	I would like to receive the first section of the formal application papers for membership with SAM.
	I am not yet ready to apply as a member of SAM, but would like to continue in correspondence with SAM.
	I would like a personal visit or telephone call from someone at SAM.

Additional comments or requests:

I have read, accept and agree with the SAM doctrinal statement.