Trevecca Nazarene University

I am applying for:

Fall Break - Chattanooga

First & Last Name:

TNU ID#:

Email Address:

TNU Box # or Address (If off-campus):

Contact #:

Date of Birth:

Classification (Fr, So, Jr, Sr, Staff, Faculty, Admin):

T-shirt Size (S, M, L, XL, XXL):

Major (religion, biology, undecided, etc.):

Foreign Language? (If "yes," which one?)

Employment Positions held (past 2 years and present):

List all the Local and District Church activities that you have participated in:

Name of Local Church you attend while at TNU:

Name of Home Church:

Please summarize your Christian testimony:

List any previous mission trip experiences (if applicable):

Why do you think you should be chosen to participate in TAG?

Please list any special skills or interests that you have:

Please list TWO references (Include Name, Phone #, and Relationship):

Allergy/Medical Condition Information:

Do you have medical insurance coverage?

Yes

No

Emergency Contact (Name, Relationship, Contact Number):

Please attach a digital photo of yourself.

TAG Trip Application