Admission into the Mercer On Mission program is a two-step process.  Students interested in participating must first complete the following application, including the essay.  Applications will be reviewed by the program faculty.  Upon their approval, the student will be admitted into the Mercer On Mission.  If a particular program is full, the student will have the option to remain on a waiting list or to be considered for another program. (If you have trouble submitting the application please email the information requested to MercerOnMission@mercer.edu)

Full Name as it appears on passport:
Student ID:
Current Classification:		Freshman Sophomore Junior Senior Graduate Student
In what school or college are you currently enrolled:
Do either of your parents work at Mercer:		Yes No
Local Address:
City:
State:
Zip:
Country of Origin
Local Phone:
Email:
Emergency Contact Information:
Do you have a valid passport:		Yes No
If not US passport, identify issuing country:
MOM Program of Interest:      Kenya      Liberia      Malawi      Moldova      Mozambique      South Africa      Vietnam Engineering      Vietnam Medical		First Preference: Second Preference: Third Preference:
GPA:
Expected Graduation date:
Foreign Language:
Proficiency:		Excellent  Good  Fair
Leadership Positions:
Volunteer Involvement:
Have you been on MOM in the past:		Yes No
Answer the following question in less than 500 words:
"I am eager to participate in the Mercer on Mission program because..."
***By submitting this application you grant permission to the Director of Mercer on Mission to request from the Mercer Judicial System any pertinent information regarding previous or current investigations in which you are involved.