Escolar Documentos
Profissional Documentos
Cultura Documentos
ii
information from this form will appear in Horizons and other infor
mation formats published by Mission Services Association.
JUN. 2^
'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:
(Month
Day
Year)
m.
Name in full
Spell out alt names
First Jfame
Mame
Last Name
4ame ^
Middle Name
c<?
(Number
Street
City
Zip number
Stars
Country)
Ask for:
(First
'
Middle
/
(Number
Street
City
Slate
Zip)'
phone number
Wt'.ftyru/
r^
i^jt~.'
State
V"
/P\<aa<Jc
Zip
City:
State
Zip
Names and addresses of other sponsoring churches whose elders recommend you:
Number & Street
(Full name ol church)
City:
State
Zip
//
City:
Zip
State
Please sketch a map directing visitors to your location on the mission field
Recommendations by Christian Leaders: (List names here and enclose a copy of each letter.)
Name:
City:
State
Zip
Name
City _
Zip
State
Place of Birth
'i"/
Date of birth
state
Zip
A
(Mor\lh)
{feat)
fOsy;
(Day)
(y^a.
(Month)
(Day)
if applicable.)
(Year)
Where baptized?
City (y /
(J-
(?,
Date
d /^ h
State
Zip
c>
^^/ /
On an extra sheet please describe any details regarding your conversion which you might care to mention.,
I
MARITAL STATUS:
Married
Single
Divorced
Widowed
"
Please give the complete name of your husband or the maiden name of your wife
Date of marriage
,
(Month)
fDayJ
Where married?
(Year)
List children by full name giving the place, birthday, month and year in the order ofyourchildren's birth days. (If your
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
Please list places of previous Christian service and what service you did as a brief career summary., Give
J^
Position
<2^
Service
Dates
XLocation
y\ i
Cpll^e. (L ^ )n
M
L.
Number
of^ years
,
^
,
your
purpose
in
missions?
^^
j
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):
~7~h^T~ o^j^l
O^A (^0<J -T
liAK-J
li oP ^ o/- Sb
Describe briefly in outline form the nature of your daily duties on the field:
='/y^
y^/,n,p
^-e
Which of the following terms most nearly describes your missionary status?
Evangelist
Bible College Teacher
Bible Reader
Public School Teacher
Homemaker
ministry
Doctor
Radio follow-up
mission equipment
Name other:
Social Worker
Benevolent
Pilot
Music Teacher
Maintenance
Correspondence Courses
Evangelism
Nurse
Linguistics
Office Work
Maintenance of
Production of Bible
^c/n^
Radio
Village
PARENTS;
/t
Living
(First
Deceased
City ,
Slate
fg
Last(tame)
frame
Middle
Zip
Phone
No
is he a Christian? Yes
His occupation
y/^ n /7^,
(First
Living
City
is
she
Deceased
f
a
Yes
Lest name)
Middle
Zlp_jfZ!2-2-Z-Phone
state
Christian?
No
home
What leadership positions or Christian service has she rendered to the iocai church? ml
Do you have relatives In mission work? Yes
XJUA
cJtS
No
If SO, please list their names, location, kinship and details on a separate sheet with a brief explanation of their
missionary activity.
FORWARDING
^DING AGENT:
Name
(first
t name,
xnm.
Middle
j
j
^5^//
Zip
ui-
C. , City .(2-jjts-c..j.ei
Phone
1
d^
?
Where attend church?
City
Zip
State
7-
.t i\ ^
"y"
r//4^
T>
T/ /
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.
rdc
iMiZ.
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 fee! free to send it. MSA is depending upon you. Thanks.
Jf'
0ir
( Picture
College.
Cincinnati Bible