Application

To Apply

All Applicants if applicable, please email the following to Randy King at rand@chosenima.org:

Recent Photo
Medical/Dental Professionals must submit a copy of their diploma, credentials, privileges and current professional license. (In addition, Anesthesia Providers - please send a copy of your DEA - controlled substance registration certificate)
All Physicians: Please send a Curriculum Vitae and current list of surgical privileges, if applicable.
All Applicants must sign and submit the Release of all Claims and Liability and Conduct Guidelines form.

Please Read

ALL TRIP PAYMENTS – INCLUDING DEPOSITS – ARE NON-REFUNDABLE
Trip Cost Balance DUE 30 days prior to the first day of the trip.
COST OF THE TRIP IS $975* plus airfare to Cancun.
IF YOU ARE STAYING FOR 2 CONSECUTIVE WEEKS, THE COST IS $1,600* plus airfare to Cancun FOR THE 2 WEEKS.
Please note: Passport Expiration Date must be at least six months after the completion of the trip.

Scheduling your Trip

After we receive your application, deposit, credit card information, and/or PayPal payment, ChosenIMA will connect you to our travel agent to schedule your flight. ChosenIMA will pay for the flight, and you will reimburse ChosenIMA so the total amount you pay for this trip is tax deductible.

*Above rates are based on double or triple occupancy. You may request a single room at a rate of $1275 for one week, or $2100 for two weeks. Be sure to indicate this choice on your application.

To complete application, enter your information in the boxes below and click "Submit"

Please direct any questions to rand@chosenima.org.
Once you submit your application, we will send an email acknowledging that the application has been received, DO NOT SCHEDULE ANY FLIGHTS until you get instructions from ChosenIMA.

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Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Gender:
Date of Birth
Email
Cell Phone:
Home Phone:
Name on Passport:
Passport Number:
Expiration Date:
Second Language:
Project Name:
Medical or Non-Medical Specialty:
Emergency Contact Name:
Emergency Contact Phone:
Relationship:
Roommate Request:
T-Shirt Size:
Food Allergies:
Dietary Restrictions:

Pay Online

If you prefer to print out a copy of the application:

Word

PDF

If you are electing not to electronically submit your application and/or forms, send all necessary materials to this address:

Chosen International Medical Assistance

3638 W. 26th Street
Erie, PA 16506

Fundraising Ideas! I really want to go on a trip but…

Sometimes we feel we are supposed to go on a trip, but let the financial cost discourage us. Let me assure you – if God wants you to go, He will make a way. That is not to suggest that you can just sit back, do nothing, and expect the money to show up at your front door. Granted, I serve a God that is big enough to make that happen if He wants to, but that has not been my experience. It will take some effort on your part. So, what can you do?

Tell your church family about your trip.

Talk to your pastor, elders, or mission committee. Perhaps there is funding available that you are unaware of. Perhaps you will be allowed to make an announcement in front of the church. Depending on your specific situation, you may want to send a letter to your mission committee, and let them know about your trip and the costs involved. See if you would be allowed to have a fundraising dinner after church, or some other kind of fundraising event, and don’t be afraid to ask for help. Offer to share a presentation to your church once you return, as a way of thanking them for their support.

Write support letters.

Send letters to family, friends, neighbors, co-workers, and anyone else you can think of. Include where you are going and what you are going to be doing and the cost of your trip. Ask them to be praying for you, the trip, and the people you will be serving. And ask them to consider supporting you financially. Even though some of the people on your list may not yet know the Lord, many will still be willing to support a good cause. (It doesn’t hurt to remind them that all donations made out to Chosen International Medical Assistance are tax deductible.)

Get your community involved.

Involve your friends, family, neighbors or youth group and hold a garage sale, bake sale, car wash, auction, etc. Be creative!

Use holidays.

Instead of asking for birthday or Christmas gifts, ask family and friends to help you go on a mission trip. The sacrifice of giving up a present will pale in comparison to the joy of service Christ!

Give up something that you enjoy.

Perhaps you give up that cup of coffee every morning (or make it at home instead of purchasing it from that coffee shop), cut back on eating out, or even fast (and pray) for a few meals a week. Maybe it is not going out to the movies, a sporting event, or not buying that video game that you really want. Think about some things that you have in your life that are wants and not needs, and see if you can “give them up” for a while.

Be Grateful

Whatever you do, be sure to send thank you letters to anyone who has helped you – financially or otherwise! And, instead of thinking of this process as asking for money, remember that you are giving others an opportunity to participate in the mission trip with you!

Chosen International Medical Assistance – Projects in Valladolid

Thank you for your interest in this ministry!
Here are some important things to know about the projects scheduled for Valladolid - Mexico
If you are reading this for a minor, please review all this information with him/her to keep them in the loop

Flexibility – Regardless of what you’re good at, allow God to use you in new and unexpected ways. No job is too small or unimportant while on a project. Without each person’s unique contribution, these projects would not be possible.
Change – Expect instructions/directions/plans to change every five minutes or less – it is how things work! Always tune in to the latest….
Patience – It isn’t easy to make arrangements in the areas where we work – the people and things needed are often not readily available and ready to respond to our needs.
Additional $$$ you may need during the project: (The best place to exchange you money is at a store near the hotel. You can exchange at the airport, but you will not receive as good of an exchange rate.)
Laundry & Tips - $3 - $6 each time you wish to get your laundry done. Tipping at the hotel - $1 US per person/per day is suggested
Meals - On the weekend (if you have registered for 2 – back to back projects), you may need to pay for a couple of meals $10 - $15 each. Cultural note: please remember that, contrary to what is customary in the U.S., in Latin American cultures, it is considered rude for the waiter to bring the check before you ask for it, so please ask for it when you are ready. Plan on $20 - $25 for each outing. On travel days – plan on at least one meal each travel day $10 - $15 each. Please note that any meals/snacks/water purchased at the Cancun airport will be expensive, as is true for any airport anywhere. You may want extra money for souvenirs and some snacks $40 - $50.
Love Offering - There may be a love offering collected during the week. Donations may be collected to help the local church or to support a specific ministry.
Immunizations - There are no required immunizations to travel to Mexico. Be up to date on your tetanus shot. Many recommend that you have Hepatitis A and B. Check with your doctor for further information.
Minors (under age 18) not traveling with parents (both), should have a notarized piece of paper signed by both parents, giving the minor authorization to travel to Mexico on the appointed dates. If only one parent is living, the airlines may require a copy of the death certificate. A minor may not be allowed to leave the U.S without the required documentation.
Passport- A must for each participant. If you are not a U.S. citizen, you may need a special visa from the Mexican Consulate – you need to call the one nearest to you and find out about the requirements. It is recommended to keep it with you at all times. It is a gigantic headache if you lose it.