rim

2012 Trip Dates Here! 1.800.774.6746

goinfo@realimpact.com

LET GO of the
predictable and be astonished
by the extraordinary.

Important details at the bottom of the page after the application!!

HOW TO APPLY ONLINE:
1. Complete the application below by May 20, 2012.
2. Click 'Submit' AND THEN:
3. Pay the $29 application fee ($19 for alumni) online (look for the Paypal 'Donate' button on the 'Home, Individual or Group Trip' pages) and email a photo of yourself to goinfo@realimpact.com. Or in one envelope, enclose the non-refundable application fee of $29 (no cash please) and a photo of yourself. Mail to RIM, PO Box 701792, Tulsa, OK, 74170-1792.
4. IMPORTANT: In order to complete your application, please have your Pastor, leader or Youth Pastor, email a brief letter of recommendation for you to goinfo@realimpact.com. Have him/her include how long they have known you, observations on your relationship with Jesus and others.

Within a week, you should be accepted to a team (usually your first choice) and we will send you an acceptance packet that will include information specific to your team and country... Along with a ton of great fundraising ideas that will help get you there... And everything else you need to know about your trip. And of course, feel free to give us a call anytime with questions: 800.774.6746.

AGE REQUIREMENTS
Must be age 13 by 12/31/11 for a RIM Trip (excludes customized, youth group and family trips)

1. Type of Application
	I am applying to be a:
	If applying with a special group, name of group:
	City:
	State:
	Leader's Name:

2. Personal Information
	First Name & Middle Initial (as on Passport):
	Last Name (as on Passport):
	Date of Birth:
Must be age 13 by 12/31/11 for a RIM Trip (excludes customized, youth group and family trips)
	Age:
	Gender:
	Citizen of what country:
	Marital Status:
	Height:	(feet) (inches)
	Weight:	(pounds)
	Email Address:
	T-shirt size:

3. Address
	Permanent Address:
	City:
	State & Zip Code:
	Home Phone:
	Cell Phone:
	If you will move to your permanent address prior to the trip, what date will you be there:

4. Pastor & Church
	Pastor's Name:
	Pastor's Title:
	Church Name:
	Phone:
	Address:
	City:
	State & Zip Code:
	Country:
	Date you made a commitment to follow Christ:

5. Parents
	Father's Last Name:
	Father's First Name:
	Father's Phone:
	Mother's Last Name:
	Mother's First Name:
	Mother's Phone:
	If parents are separated or divorced, who has legal custody?:

6. Personal
	Have you ever been on a missions trip before?:
	Where:
	When:
	Organization:
	If you are in a dating relationship with someone, is this person applying to come on a Real Impact trip: ?
	If yes, name:

7. In the past year have you been involved with...
	Alcohol or Tobacco?:
	Illegal Drugs?:
	A cult or the Occult?:
	If yes to any of the above, please explain:

8. Have you ever...
	Been expelled from school?:
	Been convicted of committing a crime?:
	Served time in a juvenile detention center or jail?:
	If yes to any of the above, please explain:

9. Children
	Do you have children?:
	Will they be traveling with you?:
	List names and ages:

10. Medical - Have you ever had...
	Diabetes?:
	Seizures?:
	An Eating Disorder?:
	Psychiatric Care?:
	If yes to any of the above, please explain:

11. RIM Trips
	How did you hear about RIM?:
	If Magazine, Friend, Church or Other, please name:
	I am interested in going to (Trip I - 1 month, Trip II - 2 week):
	1st Country Choice:
	2nd Country Choice:
	3rd Country Choice:

12. Educational Training (fill out if applying for leadership)
	High School - Year Graduated & GPA:
	College - Year Graduated & GPA:

	Foreign Languages that you speak and level of ability: (basic, intermediate, fluent)

13. Leadership Profile (fill out if applying for leadership)
	Please list any leadership positions that you have held in the past:
	Have you ever led worship?:
	Instruments you play?:
	Please rate your experience in the following areas:
	Leading Small Group Bible Study:
	Public Speaking:
	Preaching to a Group of 50 or More:

14. Fitness Evaluation
	I would describe my health fitness as:

15. About Yourself
	Answer using 5-8 sentences, how you met Jesus, your current relationship w/God, and why you want to go on a mission trip / internship:


16. Leadership Essay Questions (fill out if applying for leadership)
	Answer the following with 3-5 sentences:
	What do you see as your strongest character quality? Why?


	What do you see as your weakest character quality? Why?


17. TEAM LEADER (fill out if applying for Team Leader only)
	Answer the following with 3-5 sentences:
	How do you deal with stressful situations?


	What is one area of your leadership ability that you would like to challenge?


18. SPECIFIC LIMITATIONS
	The purpose of Real Impact Missions is the ministry of the Gospel of Jesus Christ and His Church. Any available sightseeing and shopping will be permitted only if it coincides with the team's main purpose, but could be canceled if not deemed convenient for travel or time or if it hinders the ministry. Trip costs are based on Fall 2011 prices. Due to massive changes in the airline industry, it may be necessary to add an additional airline surcharge. RIM will avoid this if at all possible. Dates, travel arrangements, and schedules are also subject to change. Application fees and contributions are not refundable, due to IRS regulations. In the event of political unrest or natural disaster, Real Impact Missions will decide if and where to send a team. In the event that a team is canceled, for any reason, team members will be assigned by Real Impact Missions to another team of similar expense. Real Impact Missions is a highly disciplined organization with regulations in many areas, including conduct, dress, and Christian lifestyle. These are explained in the packet of information sent to accepted applicants. Team members, leaders, and staff adhere strictly to Real Impact Missions' policies and are subject to dismissal for disobedience without refund or reimbursement. Team members, Leaders, and Staff serve at their own risk. Real Impact Missions is not liable in the event of sickness, accident, death, terrorist acts or for transportation or any other expense beyond that of normal involvement. All donations received by Real Impact Missions go toward project expenses. To receive a tax deduction, the IRS stipulates that the donor must release control of the money donated to the non-profit organization. For this reason money cannot be refunded and cannot be designated to a specific person. The individual will be a fundraiser and will get credit for raising the funds equal to the price of the trip. If an individual is unable to participate in the Real Impact experience, the funds he/she has raised, less incurred expenses and administrative fees will remain credited to the project for one year. The Real Impact experience includes intense physical activity including extended hiking, continuous walking and strenuous choreography. We require all participants to be in good physical condition and may request a physical exam and reference from a doctor. The Information I have given Real Impact Missions is accurate and true to the best of my knowledge. My enclosed signature and/or enclosed signature of my parent or legal guardian, because l am under the age of 18 signifies my approval of all limitations listed above.

19. Signatures

	Applicant Signature & Date: (type your full name)
	Parent/Guardian Signature (Required if under 18) & Date: (type their full name)

MIAMI TRAINING

Summer training for Africa,Thailand, and Guatemala (except medical and NY) will take place in Miami, Florida at the beginning of the trip. You will spend two days training in drama, evangelism ministry process, alternative ministry, as well as meeting and building your team through group activities, praise and worship, and teachings on personal growth and development, missions, and spiritual survival on the mission field.

FINANCIAL SPECIFICS
Trip cost includes international travel, meals, lodging and transportation from the first day of training at dinner through the last day of debriefing. Trip cost does not include domestic airfare to training (Miami, FL), fees for passport or visa (if applicable), U.S. departure tax, travel insurance, drama costume cost or money for laundry and souvenirs. Any costs associated with an early return as the result of illness or serious violation of rules set forth by Real Impact Missions will be the responsibility of the individual involved. Trip costs are based on Fall 2011 prices and are subject to change. Due to massive changes in the airline industry, it may be necessary to add an additional airline surcharge to the cost of the trip. RIM will avoid this if at all possible. We can receive donations for individuals through our Paypal 'Donate' button on the 'Individual or Group Trip' pages. You will recieve credit for the amount we receive from Paypal. Make sure all donations have the missionary name in the 'Purpose' box and you click 'update total'.

REFUND POLICY
If an individual is unable to participate in the Real Impact experience, the funds he/she has raised, less incurred expenses and administrative fees, will remain credited to the project to use for one year.

TAX DEDUCTIBLE DONATIONS
Donations to Real Impact Missions are tax deductible. Real Impact Missions is a registered 501(c)3 non-profit organization. All financial activity is filed annually on a Form 990 Corporate Federal return. Checks should be made payable to Real Impact Missions and the name of the missionary should not show up anywhere on the check. We accept donations through Paypal (Paypal charges a small fee).