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MISSION SERVICES ASSOCIATION
For ottrte use only:
PERSONAL FILE FORM
Date Sent:
Date Rec'd:
Information from this form will appear in Horizons and other infor
mation formats published by Mission Services Association.
This form is prepared to help you give accurate background informa
tion about yourself and your mission work.
'Please type or print clearly *Do not abbreviate
'Please do not write on this form anything other than that requested. Attach extra sheets for additional information you may want to provide.
This is not an application form, it is not an official form endorsing you and your work. It is simply a worksheet designed to help us publicize
your work that may help produce new friends for you, prayers and financial assistance. If any questions seem too personal or seem offensive
to you, please feel free to leave them blank.
Date:
f
Day Year) (Month
Name in full
T UL\t
Spell out alt names First Name Middle Name
MiCHOLS
Last Name
Complete address on field:
Bs P-
(Number Street City State Zip number Country)
Phone number on field: In Case of Emergency call # :
Ask for:
(First Middle Last name and address)
Your complete address while in USA: P. Q >
3(o I
(Number - Street City State Zip)
KKVASKS , \LL\l^Q\S
Your USA phone number: area code phone number
^^9 - bSLOO
Name and address of Livinglink church or churches:
Number & Street
(Full name Ol church)
City State
(Full name of church)
Number & Street
City: State
Names and addresses of other sponsoring churches whose elders recommend you:
U^-e.^VuJcv>l ClArisVtan _ Number &Street l\ Ui\\ouj~a Place,
(Full name 01 church) r\
City:
Zip
Zip
PosTM-
. Ztp WAR
Coot.
CUURCU QF Number &Street RR ^ \
(Full name ol church) Q ?
City: PiCToM ^ QtsTTK^lO
posrNu ... __
_ ottq
Please send letters of recommendation from the elders In
your sponsoring churches which will encourage other
churchestosupportyourmlsslonary work. Certainly the
words of these elders will help to convince others
regarding the worthiness of your mission work. Please
help MSA to spread your news through HORIZONS by
sending these elders' letters from your sponsoring
churches as soon as possible. MSA will be happy to help
you contact these elders If you will send the full
addresses of the churches.
Please sketch a map directing visitors to your iocatlon on the mission field
Recommendations by Christian Leaders: {List names here and enclose a copy of each letter.)
Name: V\KRoV.D C-QOPE-R Number &Street
r.ity MTt^. V4Q\JLS^ t\LE^RTA, 7ip "TqM 1TQ
Name
City __
Number & Street
State Zip
Place of Birth
(Number 5 Street)
Date of birth 0^"VO RV- R \
nity fi\CTON
(Month) (Day)
(Add date of arrival
(Month)
(Year)
If applicable.)
Where baptized? _ U\es.-V Lake
City - P.cLon
(Year)
(Day)
and naturalization date
(Year) (Month) (Oay)
Date Se-p^emk-fer
PR.O^ I ij
State-_LkviajZJ^2 Zip YsOK QTo
On an extra sheet please describe any details regarding your conversion which you might care to mention..
MARITAL STATUS:
Married ^ Single Divorced Widowed
n
Please give the complete name of your husband or the maiden name of your wife
Date of marriage ^P)R ^ ^ 3^ Where married? "V ^ \ KR \Cb
(Month) (Day) (Year)
Who solemnized your wedding? C.OQP^R ^
List children by full name giving the place, birthday, month and year Inthe order of your children's birth days. (Ifyour
children have been adopted please Indicate.) In case you are single, please list your brothers and sisters by name in
this space.
Name Place of birth Month, Day Year
n
Please list places of previous Christian service and what service you did as a brief career summary. Give
approximate dates:
Place Position Service Dates
EDUCATION (high school and later):
Name of school Location Number of years Degrees granted and date
' (List honorary degrees)
PRIMCG. OU^RD CouLEC-,\KYe \N,TlTuTE
PiCToM U
ONTKglQ
Toronto Sk
What influenced you to beconne amissionary? fcfefjh Q Ar'POtyv <.tf\ce_
cVulAKooij ! becanve a. rpat\\-v| uikein T To UnouJ
TuxruW t\\iUer (^hu.r<Le uO JVK /\fricd^ CPi^iTiatv
What Is your purpose In missions? Or what do you hope to accomplish on the mission
field? "Tc^xcVt We cf W'\s loJt for Wow -J s-ej'Je 4Kow ta. cuvij uJOAj
Your own explanation In some detail might be influential in leading others into full-time service. (Use extra sheets if
you need more space):
Describe briefly In outline form the nature of your daily duties on the field:
Which of the following terms most nearly describes your missionary status?
Evangelist Bible College Teacher Bible Reader Public School Teacher Pilot
Homemaker Doctor Nurse Social Worker Music Teacher Radio
ministry Radio follow-up Christian Service Camp Linguistics Maintenance of
mission equipment Maintenance Benevolent Office Work Production of Bible
Correspondence Courses Production of Christian literature in the National Language Village
Evangelism Name other: A-garKmi^
Languages you know (fluent/non-fluent) \ i FrJr\ C,K
PARENTS:
Father's name and his home address: .
GEgK\.D Kl&ERT RKKBER
Middle - LasI name)
Living Deceased Number &Street ^ ^ ^ \
rity FoySoRq OKJTKRIQ 7ip KOk aRophnn. qioto -mi
His occupation KUT0 Pi\lNlT Is he aChristian? Yes No _k
What positions of leadership has he held in the local church?
What Christian service does he now do?
Mother's full maiden name
eHKiOR kNJ^l fiKR R-E-R
(Fifsi Middle Last name)
Living ^ Deceased Number &Street _S S ^ ^
City ft ^QO \ ^ L- Q , state- ONTKRtO
Is she a Christian? Yes No Her occupation if employed outside the
home MD '\r\ c\ W
What leadership positions or Christian service has she rendered to the local church?
Do you have relatives in mission work? Yes No
If so, please list their names, location, kinship and details on a separate sheet with a brief explanation of their
missionary activity.
FORWARDING AGENT:
Name M ftor \
(First Middle Last name. H applicable, list both Mr. and Mrs. lull names.)
Number and Street ^ ^ City P i o rv
State Oi n4-ar \o Zip K 3TQ Phone
Where attend church? ^fto-W.g- Cjrvujrtjrv CLkr
(Full name of church) _ . . ^
Number &Street R R. ^ ^ City P \CroA State \ O-T ' O zip rkOK 3TQ
What duties are performed by the forwarding agent? KaAcll'iiVQ ^ iiAances.
Should money be sent to the forwarding agent only?
\
es
Does the forwarding agent receive a salary? In what form should funds be sent? or pt&k
Please give the full name of the mission: i.J 0\a-r cKo:?^
Does the mission have official tax exempt status? J_S-
Please give details of HOW checks should be written to this mission: ftcLRe- OvuroK CJ\ri^V
If funds are to be sent directly to the missionary on the mission field, please explain the details of HOW to do it, so we
can give your explanation to HORIZONS readers and others who may Inquire
Mission Services Association is depending upon you to keep her informed regarding your missionary activity.
Thanks so very much; you are the BEST source for your information we know, so you are a vital partner.
^ If you have additional information that you think will be helpful to thestaff of MSA In preparing news stories about
your ministry, please feel free to send It. MSA Is depending upon you. Thanks.
fVCM i.', r\(.4 "tke QoV'V
Ox\aA'o-iv ra>vis. iVWeiV ngjXL- ^ ^ +Ke.'r (K yicHos f\CMi
MISSION SERVICES ASSOCIATION
For office use only:
PERSONAL FILE FORM
Date Sent;
Dateflec'd: ]
Information from this form will appear In Horizons and other infor
mation formats published by Mission Services Association.
This form is prepared to heip you give accurate background informa
tion about yourself and your mission work.
please type or print clearly *Do not abbreviate
'Please do not write on this form anything other than that requested. Attach extra sheets for additional information you may want to provide.
This Is not an application form, it is not an official form endorsing you and your work. It is simply a worksheet designed to help us publicize
your work that may help produce new friends for you, prayers and financial assistance, if any questions seem too personal or seem offensive
to you, please feel free to leave them blank.
Name in full
Spelt out all names
Complete address on field:
8. P.
Phone number on field:
Ask for:
(First Middle
/??i'cKqe|
Middle Name
(Number Street - City State
Date:
(Month
AJ o IS
li/.number Country)
In Case of Emergency call # :
Day
1113
Yaer)
Last name and address)
P.O.
Your complete address while In USA:
3(o i
Kansas ^ 11^33
(Number Street City Slate Zip)
Your USA phone number: area code phone nu mber 9VS -
S'SDO
Name and address of LIvlnglink church or churches:
Number & Street
(Full name ol church)
City
(Full name ol church)
City:
State
Number & Street
State
Zip
Zip
Names and addresses of other sponsoring churches whose elders recommend you:
fegA'tflgtJ CDI^Ti/tfl CIUjM Number &street CoiTtier af IVijUs aW Mk.) r<./dcX31H
(Full name ol church]
City:
Ajvt eto
state
XL.
Zip
n
H/ifiisTiA/O ethje.cH
Ihirhyi ^i~- / f^o< j
(Full name ol church)
City:
Number & Street
State
JZL.
Zip
61^33
Please send letters of recommendation from the elders in
Please sketch a map directing visitors to your location on the mission field
your sponsoring churches which will encourage other
churchestosupportyourmissionary work. Certainly the
words of these elders will help to convince others
regarding the worthiness of your mission work. Please
help MSA to spread your news through HORIZONS by
sending these elders' letters from your sponsoring
churches as soon as possible. MSA will be happy to help
you contact these elders if you will send the full
addresses of the churches.
Recommendations by Christian Leaders: {List names here and enclose a copy of each letter.)
Name:
City:
Name
City _
Pruc
cc SK Ieliis'
n co\ y\
Number & Street
Cc-x ^-7 V
state
rt-
Number & Street
Pov (7?
State
Place of Birth ^4. //7>yr-fa/ Q^y
(number S Street)
Date of birth J'tji y ^
State
j:l^
(Month) (Day) (Year)
(Add date of arrival
(Month) (Day) (Year)
(Year)
if applicable.)
Where baptized?
City State
and naturalization date
Date
XL.
Zip
Zip
Zip bno\
(Month) (Day)
Zip ^ I
On an extra sheet please describe any details regarding your conversion which you might care to mention.,
MARITAL STATUS:
x/
Married Single Divorced Widowed
Please give the complete name of your husband or the maiden name of your wife 'X'liV Ann
Date of marriage D^cet^ fcey- H Where married? Torowio Onhi^io
(Month) (Day) (Year)
Who solemnized your wedding? Cpoi^e*^ Ec/ A^ichols
List children byfull name giving the place, birthday, month and year inthe order of your children's birth days. (If your
children have been adopted please Indicate.) Incase you are single, please list your brothers and sisters byname in
this space.
Name Place of birth Month, Day Year
n
Please list places of previous Christian service and what service you did as a brief career summary. Give
approximate dates:
Place Position > rwoiiiv^ii
^SI-.)
EDUCATION (high school and later):
Name of school
kjunS^ SiiW
Location
Service
Number of years
IVX'lL ("iyrs)
Dates
/^7S' -
Degrees granted and date
(List honorary degrees)
-^cv.
jy^'y Coi'^ '
\VL
j^aS-Ui^ e? Ar!^ kj-e^
l\fk fv^ Ci^rtS'h*^
T^fTMiS'Vy
I
Tes/rtihe^
What influenced you to become amissionary? uAo ij^ 2^
^ i
e^s dL-
What Is your purpose in missions? Or what do you hope to accomplish on the mission
field?
Your own explanation in some detail might be influential in leading others into full-time service. (Use extra sheets if
you need more space):
iuiiU^ djLv-tA-dti^ O^'^m.^oLsla
"ffc ~y^yK-aJi^ . :)c"fr*>- -&f>
Describe briefly in outline form the nature of your dally duties on the field:
Which of the following terms most nearly describes your missionary status?
Evangelist Bible College Teacher Bible Reader Public School Teacher
Homemaker Doctor Nurse Social Worker Music Teacher
ministry Radio follow-up Christian Service Camp Linguistics Maintenance of
Pilot
Radio
mission equipment Maintenance Benevolent Office Work Production of Bible
Correspondence Courses
Evangelism L^ Name other:
Production of Christian literature in the National Language . Village
Languages you know (fluent/non-fluent) ^
OJ^ Cu/
Scvryg^ y^^e?t-cX
&
PARENTS: , Jj / i
Father's,name and his home address: ^<iur
- Middle Last name)
nprASRAH Number &Street IS~^
Living ^ Deceased Number &Street
City ^State 2ip ^-3^ Phone
His occupation f^r^se-TJ^tkn. ^ C^- |s he aChristian? Yes No
What positions of ieadership has he heid In the local church?
(7^ ye^s:.
What Christian service does he now do? Acfy\
Mother's full maiden name /.UC t//^
(First Middle Last name)
Living ^ Deceased Number &Street /S"'^
City ^ , state SCL . 7ip ^1^3^ Ptinnp/^0 )
Is she a Christian? Yes 3^ No Her occupation if employed outside the
home
What leadership positions or Christian service has she rendered to the local church? U/i/e_
Do you have relatives in mission work? Yes _ _ No
If so, please list their names, location, kinship and details on a separate sheet with a brief explanation of their
missionary activity. (^qLo
FORWARDING AGENT:
Name
IpYrv Sp-g,ce
(First Middle Last name. II applicable. list both Mr. and Mrs. lull names.)
Number and Street , City ]<'
State Zip ^ t S^ Phone
jC. (L("y OX'/yX.-v {^Jl OrzA^
Where attend church?
(Full name ol church)
Number &Street City s State ^ Zip ^^^33
*
What duties are performed by the forwarding agent? Tf\cn hy^ s /^a^c es:
Should money be sent to the forwarding agent only?
Does the forwarding agent receive asalary? In what form should funds be sent? if
Ar . r^t ^4^ /h ^ is
Please give the full name of the mission: l h/'/VTzuv ^<rs/<snn
Does the mission have official tax exempt status? ~ QiH
Please give details of HOW checks should be written to this mission: a\J'^
if funds are to be sent directly to the missionary on the mission field, please explain the details of HOW to do it, so we
can give your explanation to HORIZONS readers and others who may inquire
Mission Services Association is depending upon you to keep her informed regarding your missionary activity.
Thanks so very much; you are the BEST source for your information we know, so you are a vital partner.
If you have additional information that you think will be helpful to the staff of MSA in preparing news stories about
your ministry, please feel free to send it. MSA is depending upon you. Thanks.