Varsity Catholic Mission Camp Application
Puerto Rico: December 27th- January 6th
(Includes final 2 ½ days at SEEK 2013 in Orlando)
Applications due to Thomas.wurtz@varsitycatholic.org via e-mail
Mission Camp Application Deadline: September 28th, 2012
Legal Name (Last, First, Middle):
Name you go by:
Gender:
Are you over 18 years of age? y/n
Birth date:
Are you a student-athlete?
School:
Year in School:
Email:
Current Phone:
Current Address:
City:
State:
Permanent Address:
City:
State:
Permanent Phone:
Zip:
Zip:
Where do you go to school?:
Are you a US citizen? y/n
If not, what citizenship do you claim?
If a non-US citizen, what type of visa do you have?
When does your US visa expire?
What is your visa number?
Do you have a passport?
What is your passport number and where was it issued?
What is the expiration date?
In case of emergency, contact:
Name:
Relationship:
Address:
City/State/Zip:
Phone:
Have been involved with any FOCUS/Varsity Catholic programs in the past? Please describe:
Have you held any leadership positions through FOCUS/Varsity Catholic?
Have you had any foreign travel experience? y/n:
Do you speak any foreign languages?
If yes, which one(s)?
Fluently
Can hold a conversation
Can ask simple questions
Why do you want to participate in this particular Varsity Catholic Mission Camp?
On a scale of 0 to 5 (5 being highest) please evaluate yourself on each of the following characteristics:
 Patience through difficult situations:
 Flexibility with change or surprises:
 Ability to receive constructive criticism:
 Ability to communicate frustrations:
 Ability to reconcile with others:
 Adaptability to new foods:
 Adaptability to rough physical conditions:
 Respect for cultural differences:
(From the above) What is your greatest strength? Why?
(From the above) What is your greatest weakness? Why?
Do you have any medical problems, or a history of medical problems, including mental illness?* y/n
Could this problem impact your engagement in rigorous activity or need special attention?*
If yes, please describe:*
Are you a practicing Catholic? Do you agree with all the teachings of the Catholic Church? If you are not
Catholic, what faith do you practice and do you have concerns with being a part of a Catholic event?
How do you practice your faith on a daily basis?
Please describe a situation when you were required to follow someone in leadership. What did you do to be an
effective follower?
Give a recent example of a conflict with a peer or authority person. How did you deal with this situation?
As an assistant coach, you will be an example of Christ, exhibiting modest clothing, language and behavior,
while also maintaining a positive attitude despite difficulties. How do you see yourself living these expectations
while on mission?
What coaching experiences do you have? What playing experience do you have?
Is there anything else you would like us to know about yourself?
I affirm that the above information is true.
I understand that this application does not guarantee my invitation or participation in a Varsity Catholic Mission
Camp.
I understand that I may be prevented from participation in a mission at any point at the discretion of
FOCUS/Varsity Catholic, and may be required to review, approve, and sign FOCUS’ liability and medical
waivers and releases in order to participate in a mission.
Full Legal Name: //signed//
Date (mm/dd/yy):
*Answers to these questions have no influence on you being selected to participate in a FOCUS Mission Trip.
Thank you for your application! You will receive a phone call soon after this is received to set up a brief phone
interview regarding the camp and your application.
Sincerely,
Thomas Wurtz
Director