Debriefing Application form Please fill in the debriefing application form below: Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of birth: YYYY/MM/DDGender:MaleFemaleOtherNationality:Marital Status:SingleMarriedDivorcedSeparatedEmail address:Phone number:Address:City, Country serving inOrganisationTitle/Role in OrganisationTotal years/months in the fieldLength of stay on field this termPreferred Language for debriefing:EnglishAfrikaansOther than “someone recommended it”, why do you think you need debriefing? Please be specific.If you are currently home from the mission field, what were the reasons for coming home? Is this your first Exchange at the Cross debriefing?YesNoIf No, when and where was your previous debriefing?Please indicate when you would like the debriefing to take place. The duration of the debriefing will be 4,5 daysAre you taking any prescribed medications?YesNoIf yes, please explain:Are you under the care of a professional psychologist or psychiatrist?YesNoIf you answered yes in the question above, please explain:Which church/congregation is responsible for your release to the mission field?In case of an emergency, who will be the contact person at your church?Kindly provide a name, E-mail address as well as a telephone number.CommentSubmit