Name(Required)

First Last

Compassus Job Title(Required)

Employee ID (found on paystub or workday)(Required)

Compassus Start Date(Required)

Service Line(Required)

Supervisor Name(Required)

Email(Required)

Enter Email Confirm Email

Upload letter of recommendation from ACO, AME or ED/Division President here(Required)

Max. file size: 768 MB.

To apply, you must upload a letter of recommendation from the ACO, AME, or ED of your program. An ACO, AME, or ED can recommend more than one person. If you are an ACO, AME, ED or Medical Director, you will need a recommendation from your Divisional President to be considered. Home office team members will need a letter of recommendation from their department head. *This letter is required to be considered for the trip.

Compassus Location (City, State)(Required)

Date of Birth(Required)

Gender(Required)

Male

Female

Other

Phone(Required)

Compassus Email(Required)

Do you have a passport?(Required)

Yes

Have you ever been on a mission trip?(Required)

Yes

Do you have any medical or physical condition(s) that would prevent you from fully participating in this strenuous mission trip?(Required)

Yes

Are you capable of walking 5-10 miles a day on uneven and unpredictable terrain?(Required)

Yes

Are you capable of making non-reimbursable purchases that may be necessary for the trip (appropriate shoes, clothes, luggage, etc.) and afford upfront payment for reimbursable expenses (travel meals, transportation to the airport, etc.)?(Required)

Yes

Are you willing to be an alternate and fill in should another teammate be unable to fulfill their position?(Required)

Yes

Have you applied for the Living Hope Mission Trip in the past?(Required)

Yes

Do you have a social media account?(Required)

Yes

If you decide to share details about this trip on your social media pages, will you allow Compassus to share your posts as well?(Required)

Yes

Provide a brief summary of why you want to participate in the Living Hope Mission Trip.(Required)

If selected, you will be asked to:

Acknowledge your understanding of the recommended vaccinations to travel to South Africa which may include (there are currently only recommendations): • COVID-19 • Hepatitis A • Hepatitis B • Tetanus • MMR • Chicken Pox • Submit additional personal, health, and insurance information • Sign a personal pledge: • “I will refrain from using alcohol or tobacco while on the mission trip.” • Sign permission to be treated: • “I hereby give my consent and permission to conduct any necessary medical examinations and medical treatment while on the Mission Project. I further give permission to obtain any and all diagnostic and treatment records necessary for my medical treatment.”

Living Hope Application