Do you have any health problems? If so, please explain:

Back Problems: Asthma or allergies: Special Medication: Physical Limitations: Other Information:

What do you specifically want to do or experience while in Cambodia, including tourism activities and spiritual activities?

State briefly any previous cross cultural missions exposure including, when, where and purpose:

What is your current vocation?

List any specific skills or hobbies you have: (carpentry, music, singing, teaching, sewing etc)

Please state any other relevant information: