BIMI CONNECT Pre-Approval Application

Please Note: If you have previously been approved for the CONNECT program, login here. This form is for new applicants only.

Before you begin this form, please have the following ready:

• name information
• e-mail address and phone number
• present address
• date of birth
• citizenship/nationality
• passport details
• salvation date
• salvation testimony
• church membership information including address
• church pastor's name, phone and e-mail
• description of your current service in your church
• 2 emergency contacts (name, phone, e-mail)
• health conditions, medications, allergies, etc.
• read and agree to BIMI CONNECT Statement of Faith and BIMI CONNECT Ministry Guidelines

If you have all this information ready, it should take 10-20 minutes to complete the form depending on your typing speed.

Once you have completely filled out and successfully submitted this form, a staff member will review your submission and, if you are approved for BIMI CONNECT trips, notify you by e-mail how to continue the application process.

Contact Information   Validation Failed

First Name

Middle Name

Last Name

Suffix

Choose OneJrSrIIIIIIVVVI

Preferred Name or Nickname

Address Country

Choose OneUnited States of AmericaCanada---------------AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Antarctic TerritoryBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandColombiaComorosCongo (Brazzaville)Congo, Democratic RepublicCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEl SalvadorEgyptEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMartiniqueMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarRéunionRomaniaRwandaRussiaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSint MaartenSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSvalbard and Jan MayenSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaYemenZambiaZimbabwe

Address

Suite or Apartment Number

City

State/Province

State

Choose OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming--- Territories ---American SamoaGuamMarshall IslandsMicronesiaNorthern Mariana IslandsPalauPuerto RicoU.S. Virgin Islands--- Military ---U.S. Armed Forces – AmericasU.S. Armed Forces – EuropeU.S. Armed Forces – Pacific

Province

Choose OneAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon

ZIP Code

Postal Code

Contact Phone #

E-mail

Passport & Travel Information   Validation Failed

Do you currently have a passport?

Yes
No

Exact Name on Passport

Country that Issued your Passport

Choose OneUnited States of AmericaCanada---------------AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Antarctic TerritoryBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandColombiaComorosCongo (Brazzaville)Congo, Democratic RepublicCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEl SalvadorEgyptEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMartiniqueMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarRéunionRomaniaRwandaRussiaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSint MaartenSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSvalbard and Jan MayenSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaYemenZambiaZimbabwe

Passport Number

Passport Issuance Date

Passport Expiration Date

Have you applied for a passport?

Yes
No

Gender

Male
Female

Date of Birth

Citizenship/Nationality

Choose OneUnited States of AmericaCanada---------------AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Antarctic TerritoryBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandColombiaComorosCongo (Brazzaville)Congo, Democratic RepublicCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEl SalvadorEgyptEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMartiniqueMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarRéunionRomaniaRwandaRussiaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSint MaartenSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSvalbard and Jan MayenSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaYemenZambiaZimbabwe

T-Shirt Size

Choose OneSMLXL2XL3XL

Choose a size that fits you comfortably and appropriately. T-Shirts may shrink slightly when washed.

Church Membership Information   Validation Failed

Name of church where you are a member

Name of pastor where you are a member

Country of church where you are a member

Choose OneUnited States of AmericaCanada---------------AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBrazilBritish Antarctic TerritoryBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandColombiaComorosCongo (Brazzaville)Congo, Democratic RepublicCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEl SalvadorEgyptEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern and Antarctic TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMauritaniaMauritiusMartiniqueMayotteMexicoMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorwayOmanPakistanPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalQatarRéunionRomaniaRwandaRussiaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSint MaartenSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSvalbard and Jan MayenSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaYemenZambiaZimbabwe

Address for church where you are a member

Suite or Apartment Number

City

State/Province

State

Choose OneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington, D.C.West VirginiaWisconsinWyoming--- Territories ---American SamoaGuamMarshall IslandsMicronesiaNorthern Mariana IslandsPalauPuerto RicoU.S. Virgin Islands--- Military ---U.S. Armed Forces – AmericasU.S. Armed Forces – EuropeU.S. Armed Forces – Pacific

Province

Choose OneAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuébecSaskatchewanYukon

ZIP Code

Postal Code

Pastor's Phone #

Pastor's E-mail

Salvation and Spiritual Information   Validation Failed

Salvation

---

Are you born again?

Yes
No

When did you receive Christ? (Year)

Please briefly share your salvation testimony

Walk with God

---

Do you have a regular quiet time with the Lord?

Yes
No

Please briefly describe your current service in your local church

Have you ever led someone to the Lord?

Yes
No

Emergency Contacts   Validation Failed

Primary Emergency Contact

---

Emergency Contact Name

Relationship to Contact

Choose OneParent/GuardianSpouseSiblingFriendChildOther

Emergency Phone in the US

Emergency E-mail

Secondary Emergency Contact

---

Emergency Contact Name

Relationship to Contact

Choose OneParent/GuardianSpouseSiblingFriendChildOther

Emergency Phone in the US

Emergency E-mail

Health Information   Validation Failed

Please list any health concerns you may have

Please describe any dietary restrictions you may have

Please list any allergies you may have

Please list any medications you take which we should be aware of

Can you swim?

Yes
No

Other considerations you'd like to share with us

CONNECT Trips and Related Skills   Validation Failed

Which CONNECT trip are you interested in?

Choose OneSuriname — Aug. 19-28, 2025A Future Trip

Why are you wanting to go on this trip?

Have you attended other BIMI trips in the past?

Yes
No

Are you a medical professional?

Yes
No

Please describe your medical certification and training

Please list any foreign languages you speak and your level of proficiency

Please list other skills you might be able to use during the trip

Personal Photograph   Validation Failed

This photo upload form requires Internet Explorer version 10+, Safari, Firefox, Edge, or another modern web browser. If you have trouble uploading your photo, skip this field and e-mail your photo to connect@bimi.org. Be sure to choose a photo under 5 MB in size.

Applicant Photo (for Public Profile)

Agree to BIMI CONNECT Ministry Guidelines   Validation Failed

Please read and agree to both the BIMI CONNECT Statement of Faith and the BIMI CONNECT Ministry Guidelines before continuing.

---

I have read and agree with the BIMI CONNECT Statement of Faith

Yes
No

I have read and agree with the BIMI CONNECT Ministry Guidelines

Yes
No

Submit & Register

  Submit & Register