Operation Impact Volunteer Application 2022 1General Information2References3Guidelines and Personal Assessment4Character Asessment5Medial Release6Background Check Hidden General InformationWe are SO EXCITED that you are taking the first step in joining us this Summer to make an eternal impact! Just as a heads up, this application will take approximately 30 minutes to complete. At any time, you may choose to save and continue later. A link will be sent to your email that you can use to resume working on your application. To complete this application, you will need your Social Security Number, Driver’s License (If you have one), email addresses for three references, and a parent’s signature. If you don't have these right now, stop and get them, it will help speed up the process for you once you get started 🙂Name* First Middle Last Primary name you go by Are you coming to OI to serve as a student or a staff member?* Student Staff Are you an OI Alumni or a First Timer?* Alumni First Timer HiddenAre you an alumni or a first-timer? (Hidden) Alumni First-Timer What is your role as a staff member?* Assistant Team Leader RA Media Team Other Age* Birth date*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Recent Photo*Accepted file types: jpg, gif, png, pdf, tif, rif, Max. file size: 128 MB.Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is this your permanent home address?* Yes No Please list any other places you have lived in the past 5 years.*Please use a "," between the items.T-Shirt Size*You will be receiving three Operation IMPACT T-shirts. Please choose your size. Extra Small Small Medium Large Extra Large Home phone*Personal cell phone*Please note, we require all attendees to bring a cell phone. A phone with minute cards is a great option.What is the best way to reach you? Home phone Cell Phone Email Church InformationChurch* Are you currently a member? Yes No How long have you been a member? Church address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Church phone*Church website* Please list any other churches you have attended regularly in the past five years.Please use a "," between the items. Denomination* Parent InformationFather's email address* Mother's email address* Parents' full names*(if you are from Mexico, please include your mother's maiden name)Father'sMother'sParents' cell phone numbers*Father'sMother'sPlease indicate an email address to send the Parents' Perspective Form to.* Please indicate the first names of the parents who will be receiving the Parents' Perspective Form.*Example: Bob and Sharon Dates and CostPlease select your sign up rate* Early Sign Up $450.00 (ends April 30th) Regular Sign Up $550.00 (ends May 24th) Attending Discount (Hidden)Congrats! If you're coming to Operation Impact, you automatically get $100 off, complements of the ITG team! Price: Group Discount* I invited a first-timer who is attending OI with me. I am a first-timer who was invited by someone who is also attending OI. Neither List the name(s) of the people you invited.Please put the first and last names. If you invited multiple people, please use a "," between the names. (Note: Your discount will be finalized once one of the invitees registers) Who were you invited by?Please put the first and last name. (Note: They must be registered before your discount will be finalized) HiddenPlease list the name(s) of the friend(s) you are bringing: (Hidden)Please use a "," between the items. $20 Deposit There will be a $20 deposit for your dorm room. - Please bring Cash for your deposit to registration. - Please do not send the deposit in beforehand. Note: Your deposit will be returned to you as you leave at the end of OI, given that your room passes the cleaning checklist and final inspection. Deposit (Hidden)There will be a $20 deposit for your dorm room. - Please bring Cash for your deposit to registration. - Please do not send the deposit in beforehand. Note: Your deposit will be returned to you as you leave at the end of session, given that your room passes the cleaning checklist and final inspection. Price: Promo Code (if applicable) Student's signature*You agree that the above information on this page is true and accurate. Total $0.00 ReferencesReference requirements: 1. The reference must be 18+. 2. They must know the applicant personally. 3. They cannot be related to the applicant in any way, and must be separate individualsWe will send you and your references a reference form email that your references can fill out. It will be your responsibility to ensure that these are submitted. Note: Please know that a quick reply from these sources is your responsibility, and delayed responses will slow your application process.Name of Pastor/Church Leader* First Last Title or Prefix of Pastor/Church Leader* Pastor Mr. Mrs. Ms. Miss Dr. Rev. Enter your pastor/church leader's email address.*We will send you and your pastor/church leader the reference form link. It is your responsibility to ensure it is submitted. Name of Employer/Teacher* First Last Title or Prefix of Employer/Teacher* Mr. Mrs. Ms. Miss Dr. Pastor Rev. Enter your employer/teacher's email address.*We will send you and your employer/teacher the reference form link. It is your responsibility to ensure it is submitted. Name of General Reference* First Last Title or Prefix of General Reference* Mr. Mrs. Ms. Miss Dr. Pastor Rev. Enter your general reference's email address.*We will send you and your general reference the reference form link. It is your responsibility to ensure it is submitted. Additional informationHiddenWould you like any information/materials on raising support? (Hidden)*Sponsors may send tax-deductible gifts on your behalf to In The Gap. Please check the box below if you would like us to send you an information packet on how to raise support. Yes please No thank you Have you ever been asked to leave a church, or otherwise terminate your voluntary service to any program?* Yes No Have you ever been a victim of physical, sexual, or emotional abuse?* Yes No I'm not sure Have you ever been accused of abusing anyone sexually?* Yes No Have you ever been charged with child abuse or a crime involving actual or attempted sexual, physical, or emotional abuse?* Yes No Have you ever been convicted of a felony?* Yes No Arrested or charged with any criminal offense, including traffic violations?* Yes No If yes, please explain.Have you ever had any painful life experiences as a child/minor that would hinder you from a productive ministry with children?* Yes No I'm not sure If yes or unsure, please explain.Is there anything that would call into question your being entrusted with the supervision, guidance, and care of a child or young person?* Yes No If yes, please explain.Personal QuestionnaireYour honest response to the following questions will help us get to know you better, be able to serve you more effectively, and discern your readiness to serve with us here at In The Gap. Why are you applying for this ministry?*What are you hoping to learn during Operation IMPACT?*Please describe your relationship with Jesus Christ.*Please describe your daily prayer life.*Please describe your relationships with your father and mother.*Please describe your relationships with your siblings.*While serving here at In The Gap, team members are not allowed to pursue any romantic relationships (includes all flirting, serious or casual). Are you willing to wholeheartedly abide by this policy?* Yes No Undecided Are you willing to pursue and maintain integrity in the area of moral purity?* Yes No Unsure Please describe what pursuing moral integrity and purity means to you on a daily basis (includes thoughts, emotions, words, actions, and interactions with the opposite sex).*What is one difficult character quality the Lord has been teaching you?*Please explain.How did you find out about the In The Gap?*What experience do you have working with children?*Please list the ministry opportunities you have worked with during the past 2 years, and the names of those who were responsible for you (includes summer camps, VBS, church volunteer work, etc.).*Please list the places you have worked as an employee or volunteer over the past five years.*Include the name of the business/organization, the people you worked under, and a phone number for each.Student Signature*You agree that the above information on this page is true and accurate. Personal Character AssessmentThis assessment is designed to help you evaluate your character strengths and weaknesses, as well as to help you make an action plan for personal growth. Please evaluate yourself openly and honestly. (Assessment used by permission. ©TEACH Institute, www.teachinstitute.org)Hungers after righteousness and is growing in personal devotion to Jesus*Related character qualities: Wisdom, Faith, Virtue, Loyalty 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Able to share your faith with others*Related character qualities: Persuasiveness, Boldness, Alertness 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Maintains good eye contact*Related character qualities: Attentiveness, Boldness, Clear Conscience 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Exhibits a grateful attitude*Related character qualities: Gratefulness, Contentment 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Is polite in speech and manner*Related character qualities: Deference, Enthusiasm, Flexibility, Hospitality, Availability 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Is neat and well groomed in personal appearance*Related character qualities: Orderliness, Deference, Initiative 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Allows God to direct your life through those in authority*Related character qualities: Reverence, Loyalty, Alertness, Wisdom 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Reacts positively to correction*Related character qualities: Humility, Sincerity, Discernment, Self-Control 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Cheerfully obeys instructions without delay*Related character qualities: Obedience, Availability, Virtue, Justice 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Appeals to one in authority with a respectful attitude (no whining or arguing)*Related character qualities: Discretion, Meekness, Creativity 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Maintains a clear conscience by asking forgiveness for wrong actions, words, and attitudes*Related character qualities: Responsibility 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Is honest and upright, even when there are consequences*Related character qualities: Truthfulness, Sincerity, Virtue, Justice 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Puts forth best effort in choosing and finishing a task*Related character qualities: Initiative, Decisiveness, Thoroughness 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Accomplishes assignments on time*Related character qualities: Determination, Diligence, Dependability 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Work area and assignments are neat and orderly*Related character qualities: Orderliness, Diligence, Responsibility 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Willingly shares possessions with others*Related character qualities: Generosity, Sensitivity, Faith 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Shows concern in meeting the needs of others*Related character qualities: Gentleness, Fairness, Compassion, Hospitality 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Respects the rights, feelings, and property of others*Related character qualities: Sensitivity, Loyalty, Humility, Punctuality 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Responds correctly when tempted to become angry*Related character qualities: Humility, Contentment, Flexibility 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Conquers bitterness by forgiving, praying for, and investing in the lives of offenders*Related character qualities: Love, Patience 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Does not seek revenge or tattle on offenders*Related character qualities: Meekness, Tolerance, Forgiveness 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Relates well to all members of the family, and works to resolve conflict*Related character qualities: Gratefulness, Patience, Gentleness 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Is not attracted to the world's temporal values*Related character qualities: Contentment, Security, Discernment 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Shows ability to stand alone for what is right and resist peer pressure*Related character qualities: Courage, Boldness, Virtue, Endurance 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Uses time and resources wisely*Related character qualities: Wisdom, Punctuality, Thriftiness, Resourcefulness 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Resists folly and foolishness in speech and action*Related character qualities: Deference, Self-Control, Cautiousness, Discretion 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Demonstrates discipline in personal devotion to Jesus*Related character qualities: Wisdom, Faith, Virtue, Endurance, Determination 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Has a curiosity to learn (within boundaries), and is self-motivated*Related character qualities: Enthusiasm, Initiative, Creativity 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) Thinks clearly, walks circumspectly, and makes sound decisions*Related character qualities: Alertness, Persuasiveness, Wisdom 1 (very rarely) 2 (occasionally) 3 (sometimes) 4 (more often than not) 5 (consistently) From the above assessment, what are the top three areas of needed growth along with an action step that would help you grow in that area?Area 1* Action Step 1*Area 2* Action Step 2*Area 3* Action Step 3*Based on the above assessment, what would you say are your three character strengths? What would you say make them your strengths?What are three character qualities you struggle with? Why do you struggle with those three?What are three character qualities you feel God is challenging you to grow in?What action is God asking you to take in these three areas?Student Signature*By typing your name here, you are acknowledging that the information above is accurate and honest. This is your legal signature. HiddenFather's Signature (or mother's signature, if applicable)By typing your name here, you are acknowledging that you have reviewed the above character assessment with your student, and that the above answers are a true reflection of his/her character. This is your legal signature. Release of Liability and Medical ConsentPlease read release carefully. All typed signatures are legally binding.Full name (first, middle, last).*I, the below stated, in consideration for the training and the experience which I will receive through volunteer service projects with In The Gap, do hereby release In The Gap, as well as its employees, agents, and voluntary helpers (releasees) from any and all liability arising from any and all injuries to myself, or property damage to my belongings, which may occur while I participate in service with In The Gap. I recognize the potential for physical injury to which I may be exposed in the course of my training and service, but I knowingly and freely assume all such risks, even if arising from the negligence of the releasees or others, and I assume full responsibility for my participation. In consideration of the aforementioned benefits, I voluntarily authorize In The Gap, and any of its employees, agents, or other volunteer supervisors responsible for my well-being, to personally provide or to make reasonable arrangements for any emergency medical care which should become necessary while I am participating/working with In The Gap. I understand that, should emergency care be necessary, my emergency contacts (as referenced below) will be contacted as soon as is reasonably possible. I further state that I have carefully read the liability and medical release below, that I understand it's content, and that I willingly agree to the contents thereof. I fully understand the arrangements made for my personal care, and willingly consent to In The Gap's provision for my spiritual, emotional, mental, and physical welfare during the period of time I am under the authority of In The Gap. I voluntarily, and of my own free will, sign this release of liability and medical consent form. First Middle Last Student signature*By typing your name here, you are signifying that you have read, understand, and agree to the above release. This is your legal signature. Today's date* MM slash DD slash YYYY Parent signature (if student is under 18)By typing your name here, you are signifying that you have read, understand and agree to the above release. This is your legal signature. Today's date MM slash DD slash YYYY Parent's phoneAdditional contact in case of emergency*Please indicate name, relationship, and phone number.NameRelationshipPhone number Insurance company (if applicable) Insurance Policy Number (if applicable) Date of birth* MM slash DD slash YYYY Blood type (if known)* Are you allergic to any medications? If yes, please indicate what types.*Please use a "," between the items. HiddenAre you allergic to any medications? If yes, please indicate what types. (Hidden)Please use a "," between the items.Are you currently using any form of medication (including over the counter medication)? If so, what types?*Please use a "," between the items. HiddenAre you currently using any form of medication (including over the counter medication)? If so, what types? (Hidden)Please use a "," between the items.Do you have any known food allergies? If so, please indicate what types, and the severity of each allergy. If you have serious dietary restrictions please contact [email protected]*Please use a "," between the items. HiddenDo you have any known food allergies? If so, please indicate what types. (Hidden)Please use a "," between the items. Background Check InformationPlease read authorization carefully. All typed signatures are legally binding.Full name*In connection with my future involvement as a staff member or a volunteer working with youth or children, I, the below stated, understand that In The Gap and/or its agents, may conduct a background check and obtain all records whether they are of a public, private, or confidential nature to determine my ability to minister in this role. It may include information concerning my character, work habits, performance, and any court records that may have a bearing on my job responsibilities. I acknowledge that a telephonic facsimile (fax) or photographic copy shall be as valid as the original. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, schooling agency or its agent, to furnish the information described above. In addition, I release and discharge In The Gap and its agents and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs, expenses, or any other chard or complaint filed with any agency arising from retrieving and reporting this information. I understand that if any of those records contain information that is used to deny my services at In The Gap, I will be notified of my rights and where I can obtain a copy of the information. I understand that a complete listing of my rights under the Fair Credit Reporting Act can be obtained at www.ftc.gov/credit. First Middle Last Student signature*By typing your name here, you are signifying that you have read, understand, and agree to the above authorization. This is your legal signature. Date* MM slash DD slash YYYY Social Security Number* Birth date* Month Day Year HiddenName (Hidden) First Last Gender* Male Female Race* African American Caucasian Asian Hispanic Do you have a current driver's license?* Yes No What is your license number and state? Other or former names Current address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country HiddenAll other resident home addresses for the past 5 years (Hidden)All other resident home addresses for the past 5 yearsPlease use a "," between the items. Parent signature (if student is under 18)By typing your name here, you are signifying that you have read, understand, and agree to the above authorization. This is your legal signature. Today's date* MM slash DD slash YYYY Policy AgreementsIn preparation for this section, please read the Child Protection Policies and Statement of Faith, and the In The Gap Guidelines found below.ITGOperationImpact-CPPITGOperationImpact-SoFITGOperationImpact-CombinedGuidelinesStudent Signature*By typing your name here, you are signifying that you have read the above stated Child Protection Policies and Statement of Faith and the In The Gap Resident Guidelines, and that you understand and are willing to wholeheartedly abide by their contents. Also, by typing your name below, you are indicating that you recognize this is a legally binding agreement, that all answers you have given are true and complete to the best of your knowledge, and that you are giving In The Gap the right to use your pictures, voice and testimony for promotional materials. This is your legal signature. Today's date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent signature*By typing your name here, you are indicating that you have reviewed and agree with the In The Gap guidelines, have discussed them with your son/daughter, and will encourage him/her to abide by these guidelines. You are also giving In The Gap the right to use your student's pictures, voice and testimony for promotional materials. This is your legal signature. Today's date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PaymentWhat payment method will you be using? Raise Support (Due June 1st, 2022) Pay now by Credit Card Pay by Check (Due June 1st, 2022) You've chosen the Check OptionThank you! Please read carefully: Payment in full is required by the June 1st deadline. Your check needs to be mailed with a postmark no later than June 1st, 2022. Please make checks out to: In The Gap (with your name in the memo line) Then please send payment to: Operation Impact 5517 NW 23rd St. Oklahoma City, OK 73127 Yes, I'm fine with that No, I changed my mind. I want to choose another payment option. You've chosen the Credit Card OptionThank you! Credit Card payment information will be available after you press the Submit button at the end of this form. Yes, I'm fine with that. No, I changed my mind. I want to pick another payment option. You've chosen the Raising Support OptionThank you! We will send you an information email on how to raise support and send in donations. Note: Payment in full is required by the June 1st deadline. Please send payment to: Operation Impact 5517 NW 23rd St. Oklahoma City, OK 73127. More information will be included in the information email on raising support. Yes, I'm fine with that. No, I changed my mind. I want to pick another payment option. Submit Your Application!At the end of the application when it asks for your payment information, if you are not paying now, just exit the PayPal tab and know that we have received your application.Enter your email address and we'll send you the information!* Product Name (Hidden) Price: $0.00 Quantity: NameThis field is for validation purposes and should be left unchanged. Δ
