Liberty
University
Spanish
CAMPAIGN
APPLICATION
Institute
434.582.2091  detowles@liberty.edu Website
Dear prospective Spanish Institute student:
Thank you for your interest in Spanish training and ministry. The Institute consists of two
months in Guatemala—the first of which consists of partial immersion with extensive team
ministry while the second month features total immersion with the level of ministry largely
determined by the student.
 Month 1, Partial Immersion—Primary Elements:
o Spanish Instruction
 Students will enroll in college-level classes (Spanish 102 or above) that
they will take during their first month in Guatemala.
 These classes will feature the vocabulary and grammatical structures
typically confronted in the Guatemalan culture, with particular training
in the Plan of Salvation, personal testimony and other elements directly
related to ministry in Spanish-speaking countries.
o Ministry such as the following:
 Medical clinic
 Orphanage
 Christian school
 Evangelistic programs:
 In churches
 In schools
 In parks and on street corners
 In poor villages while also sharing food and medicine
 Painting homes in poor villages
 Home construction in poor villages
 Church building construction
 Month 2, Total Immersion—Primary Elements:
o Home stays with families who only speak Spanish
o Work and/or ministry designed to aid in fluency
Please take a few moments right now to review this material, and then promptly complete the
information forms and return them today. We thank you for your sincere commitment to
developing the language and ministry skills necessary to reach the lost of Guatemala.
Your campaign cost covers airfare, housing, meals, ground transportation, literature, insurance,
visa costs, etc. For all intents and purposes the campaign fee will cover all ministry and living
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expenses incurred from the time you leave Liberty until the time you return. Your campaign
fee does not include passport fees, passport/visa photo fees, and vaccinations and/or
medications needed for the campaign.
____________________________________________________________________________
CHECKLIST
I. Complete this form and return it to me at detowles@liberty.edu.
II. In to the Department of English and Modern Languages (DH 2155). Submit the $45
non-refundable fee (this is not included in the campaign cost).
III. Print the Reference Form and forward it to your pastor
IV. Passport – signed with your full legal name
--------------------------------------------------------------------Liberty University Spanish Institute
Application for Cross Cultural Training in Ministry and Language
Campaign Country: ___________________
Dates: ___________________________
I. General Information
Name (as it appears on your passport)
Last: ________________________ First: ______________________ Middle: ___________
Date of Birth (mm/dd/yy) ________________________ Current Age ____________________
Address (both mailing and permanent):
Mailing Address (LU Box/Commuter): ______________________________________
______________________________________________________________________
City/State/Zip: _________________________________________________________
Permanent Address: _____________________________________________________
______________________________________________________________________
City/State/Zip: _________________________________________________________
at Liberty
at WORK
Telephone
E-mail
Cell Phone
II. Personal Information
Gender (M/F): ____ Occupation: ______________________ Employer: _______________
School Attending: ____________ Level of Education (circle one) FR SOPH JR. SR.
Marital Status: Single _______ Married _______ Spouse’s Name: ____________________
Do your parents (or spouse, if married) favor or oppose this missionary endeavor? If opposed,
why?________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Shirt Size (circle one)
S
M
L
XL
XXL
XXXL
(women’s only)
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III. Travel Information
Passport Number: _____________________________ Citizenship: _____________________
Date of Issue: ______________________________ Date of Expiration: __________________
Place of Birth (city/state/country):_________________________________________________
Issuing Authority: _____________________________________________________________
IV. Field Ministry
A.
Christian Service
How long have you been a Christian? _______________________________________
What do you feel are your spiritual gifts? i.e. service, giving, teaching, exhortation, etc.
______________________________________________________________________
all past
short term mission trips in which you have participated:
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Country
B.
Dates
Agency
Raised
Support?
Y/N
Y/N
Y/N
Y/N
Type of
Ministry
Skills
Do you speak any foreign language fluently? Yes____ No ____
Language(s): _________________________________________________________
List any areas of work experience and work skills which you feel are above average.
_____________________________________________________________________
_____________________________________________________________________
Do you sing? Yes____ No ____ Part: Soprano____ Alto ____ Tenor____ Bass ____
Do you play an instrument? Yes____ No ____ If yes, list: _____________________
_____________________________________________________________________
Considering your spiritual gifts, past experiences, and practical skills, what do you think
your major contribution(s) to the team could be (i.e. drama, music, encouragement,
evangelism, youth ministry, teaching, teaching English, discipleship, sports ministry,
construction, etc)?
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
V. Emergency Information
Emergency Contact #1 (Parent/Guardian/Spouse)
Full Legal Name: _____________________________________________________________
Relationship to you: ___________________________________________________________
Address:_____________________________________________________________________
City/State/Zip: _______________________________________________________________
Telephone: HOME ( )________________ WORK ( ) __________________________
CELL ( ) _______________ _ OTHER ( ) _________________________
Email Address _______________________________________________________________
Emergency Contact #2
Full Legal Name: _____________________________________________________________
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Relationship
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to you: ___________________________________________________________
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Address:_____________________________________________________________________
City/State/Zip: _______________________________________________________________
Telephone: HOME ( )________________ WORK ( ) __________________________
CELL ( ) _______________ _ OTHER ( ) _________________________
Email Address _______________________________________________________________
VI. Medical Information
NOTE:
THIS INFORMATION WILL BE KEPT CONFIDENTIAL. SINCE THIS
INFORMATION IS VITAL TO PROVIDING CARE FOR OUR
STUDENTS, PLEASE SUPPLY INFORMATION AS COMPLETELY
AND AS ACCURATELY AS POSSIBLE.
Medical Insurance
Policy #
Insurance Company Phone
Group #
(warning: insurance may not be valid overseas)
Family Doctor or Clinic_______________________________ Phone #: ( ) _____________
Address: ____________________________________________________________________
City/State/Zip: _______________________________________________________________
Glasses/Contacts (circle one) YES NO
Immunizations (with dates):
Diphtheria/Tetanus
Polio booster
Hepatitis B
Hepatitis A
Measles 
Mumps  OR
Rubella 
Typhoid
Yellow Fever
Meningiococcus (Menomune)
Other (specify)
_______Other (specify)
MMR _______Other (specify)
_______Other (specify)
Allergies:
Foods
Drugs/Medication
Environmental Factors
Current Medications (include over the counter medication, herbal products, birth control pills
and dosage of all medications):
1.
2.
3.
4.
5.
6.
7.
8.
9.
Medical History:
NOTE: If you answer yes to any of the following, please explain in the space below







Heart Disease?
Specify
Asthma?
Last Attack?
Seizures?
Last Event?
Eating Disorder?
Depression or other mental health/emotional issues?
Risk of immune deficiency?
Pregnancy?
Due date?
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 Intestinal or stomach problems?
Specify
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Is there anything that would prohibit you from fully performing what would be expected of
your participation on a language and evangelism training trip with the Liberty University
Spanish Institute?
Yes___ No___ If yes, please explain
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Signature: ___________________________________________ Date: ___________________
By signing here you verify that all information in Section VI is current and valid
VII. Ministry Information
Home Church: ________________________________________________________________
Pastor: ________________________________ Telephone: (
) _______________________
Address: _____________________________________________________________________
City/State/Zip: ________________________________________________________________
I, ________________________, certify that all information that has been submitted in this
application is both accurate and complete.
______________________________
Signature
_________________________
Date
______________________________ ______________________________ _______________
**Print Name
**Signature of Parent/Guardian
Date
**Parent/Guardian signature is only necessary if you are under the age of 18.
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LIBERTY UNIVERSITY SPANISH INSTITUTE CAMPAIGN POLICY AGREEMENT
I realize that the following elements are crucial to the effectiveness, quality, and safety of our
campaign together. As a member of the campaign team, I agree to:
1. Remember that I am a guest working at the invitation of a local missionary or pastor.
2. Remember that I have come to learn, not to teach. I may run across procedures that I feel are
inefficient, or attitudes that I find closed minded. I’ll resist the temptation to inform our hosts
about, “how I do things.” I’ll be open to learning other people’s methods and ideas.
3. Respect the host’s view of Christianity. I recognize that Christianity has many faces
throughout the world, and that the purpose of this trip is to witness and experience faith lived
out in a new setting.
4. Develop and maintain a servant’s attitude toward all nationals and my teammates.
5. Respect my team leader(s) and his or her decisions.
6. Refrain from gossip. I may be surprised at how each person will blossom when freed from the
concern that others may be passing judgment.
7. Refrain from complaining. I know that travel can present numerous unexpected and undesired
circumstances, but the rewards of conquering such circumstances are innumerable. I’ll try to
be creative and supportive.
8. Respect the work that is going on in the country with the particular church, agency, or
person(s) with whom we are working I realize that our team is here for just a short while, but
that the missionary and local church are here for the long term. I will respect their knowledge,
insight, and instructions.
9. Refrain from negative political comments or hostile discussions concerning our host country’s
politics.
10. Remember not to be exclusive in my relationships. If my sweetheart or spouse is on the team,
we will make every effort to interact with all members of the team, not just one another.
11. Refrain from any activity that could be construed as romantic interest toward a national. I
realize certain activities that seem innocuous in my own culture may seem inappropriate in
others.
12. Abstain from the consumption of alcoholic beverages or the use of tobacco/illegal drugs
while on the trip, this policy works in conjunction with adherence to the entire Liberty Way.
I hereby understand that The Institute reserves the right to take the necessary action if I
not comply to this policy agreement.
______________________________ ______________________________
Print Name
Signature
do
_______________
Date
______________________________ ______________________________ _______________
**Print Name
**Signature of Parent/Guardian
Date
**Parent/Guardian signature is only necessary if you are under the age of 18.
_______________________________________________________________________________________
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Campaign Contract
State of Virginia
City of Lynchburg
By signing this contract I am indicating that I would like to participate in a trip with the Liberty University
Spanish Institute, and I plan to secure the funds necessary to do so. I realize that all checks should be made
payable to LUSI (Liberty University Spanish Institute) and sent to the same at: Liberty University, 1971
University Blvd., Lynchburg, VA. 24502-2269, and all moneys will be established with the submitting of a $45.00
non-refundable application fee.
If I am able to participate in the campaign, the stated campaign cost and any money used to secure my support will
be deducted from my account. In the event of insufficient funds necessary for me to participate in the campaign,
any charges incurred in my attempt (i.e., airline cancellation fees when applicable) will be deducted from my
account, and I will be responsible for any deficit.
Any funds remaining in my account may be left intact for use in a future campaign within one year, transferred to
another campaigner’s account, or may, upon written request from those who contributed the
funds, be refunded. At the end of one year, any funds remaining in my account will become the property
of LUSI, and all records of my account will be destroyed.
_____________________________________________________________________________________
Campaign Release Form
State of Virginia
City of Lynchburg
I, the Undersigned, desiring to visit foreign countries with the Liberty University Spanish Institute of Lynchburg,
Virginia, do hereby release and forever discharge the Institute from any and all claims for injuries or damages I
might have in the future as a result of my travel within the United States of America as well as visiting foreign
countries, including my stay in any such foreign country, and travel to and from any such country. This release
applies both during the first month, when classes are conducted by Liberty faculty, and during ensuing months,
when students will be fulfilling internship and independent study requirements without the direct supervision of
Liberty University faculty.
I am eighteen (18) years of age or older, and this RELEASE is binding on me and my Executor, Administrators,
and heirs. If I am younger than the age of eighteen (18) my parent or legal guardian signature must also be
included below.
I further give the Institute and/or their representative with me on any such trip, authority to request medical and/or
hospital treatment for my benefit in the event of any injury or sickness sustained by me while traveling to and from
any foreign country.
**SIGN ONLY IN PRESENCE OF A NOTARY PUBLIC**
_____________________________________________________________________________________
I HAVE FULLY READ THE ABOVE AND UNDERSTAND THE SAME.
______________________________________
Signature
________________________
Date
______________________________________
________________________
Signature of Parent or Legal Guardian (Only necessary if under the age of 18) Date
_____________________________________________________________________________________
FOR OFFICE USE ONLY:
CITY OF:________________________________
STATE OF:________________________________
The foregoing release was acknowledged before me this _________ day of _________, 20_________ by
_______________________________________. My Commission expires:________________________.
____________________________________________
Notary Public
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POWER OF ATTORNEY
STATE OF VIRGINIA
CITY OF LYNCHBURG
________________________________________________________________________
LIMITED POWER OF ATTORNEY ENDORSEMENT PURPOSES
Know all people by these presents, that the undersigned does hereby make,
constitute, and appoint the Liberty University Spanish Institute of Lynchburg,
Virginia its employees and its agents, my true and lawful attorney in face, for me
and in my name, place and stead, to endorse all checks, warranties, and drafts
payable to the undersigned, or the order of the undersigned, or which may be
cashed upon the undersigned’s endorsement, and to deposit the proceeds thereof
in an account of The Liberty University Spanish Institute and/or Liberty
University for its own use, in any bank, trust company, or savings and loan
company it may choose. This Power of Attorney shall not terminate on my
disability.
***SIGN ONLY IN THE PRESENCE OF A NOTARY PUBLIC***
________________________________________________________________________
I HAVE FULLY READ THE ABOVE AND UNDERSTAND THE SAME.
___________________________________
Printed Name
__________________________________
Social Security Number
________________________________________________________________________
Residence: Street
City
State
Zip Code
______________________________________
Signature
________________________
Date
FOR OFFICE USE ONLY:
CITY OF:__________________________
STATE OF:_________________________
The foregoing release was acknowledged before me this _____ day of ________, 20_____ by
_____________________________. My commission expires: __________________.
______________________________
Notary Public
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Financial Deadline Agreement
To ensure that funds are available at the appropriate times, the Institute sets up a series of
deadlines.. Typically, expenses such as airfare deposits, airfare costs, housing and food
deposits, in-country transportation, etc. must be covered well ahead of the time when the trip
actually takes place.
The deadlines for your campaign will be made available to you in your first campaign meeting
with your leader present to explain costs and dates.
By signing below you are agreeing to adhere to the deadlines set up for the trip for which you
are applying.
_________________________________
________________________________
Printed Name
Signature
_________________________________
________________________________
Date Signed
Country
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