student_application

Checking this box acknowledges that I have read the expectations agreement, outlining my responsibilities and the church's responsibilities. I understand that if I or the church chooses to terminate this agreement before the time of scheduled completion, the remaining funds of this grant are to be returned to the Cooperative Baptist Fellowship within 6 weeks.:

Your Full Name:

Name You Prefer:

Have you already committed to serve at a specific church this summer? If so, please enter the church name and the city/state in which it is located:

If you have not already committed to serve a church, we will help match you with a congregation. Please enter (in order of preference) where you would like to serve. You may enter locations, specific churches (please include city/state), or no preference.:

Birthday:

E-mail:

If married or engaged, enter your wedding date:

Full Permanent Address:

Full School Address (if different from permanent address):

Home Phone:

() -

Cell Phone:

() -

School Phone:

() -

I am:

MaleFemale

Name, City and State of the high school you attended:

Dates attended (Month/Year):

Did you graduate?:

YesNo

Name, City and State of the college you attend/attended:

Dates attended (Month/Year):

Have you graduated?:

YesNo

What was your degree/major?:

(If you have attended a second university) Name, City and State of the college (or seminary):

Dates you attended (month/year):

Did you graduate?:

YesNo

What was your degree/major?:

Name, City and State of previous employer:

Dates Served (Month/Year):

Position:

Supervisor's Name:

(If you have held more than one job) Name, City and State of previous employer:

Dates Served (Month/year):

Position:

Supervisor's Name:

Other employed experience you wish to share (300 character maximum):

Name and mailing address of church where you are a member:

Pastor's Name:

Denomination:

Name and mailing address of church you attend during school (if different from home church):

Pastor's Name:

Denomination:

List church activities in which you have been or are currently involved (200 character maximum):

List places/dates of previous ministry experiences (200 character maximum):

Other languages (rate your proficiency):

Do you have experience in the following? (Press CTRL to select multiple options):

Please list any other skills (150 character maximum):

Describe your initial encounter with Jesus Christ and other experiences since that time that have helped you grow in your Christian faith (1500 character maximum):

What factors (home, church, school, others) have helped or hindered your growth as a person (your perception of yourself, your goals and purpose in life, your lifestyle)? (1500 character maximum):

What is your understanding of the internship for which you are applying? Why are you applying? What goals do you have? How do you hope to achieve them? (1500 character maximum):

What are your strengths and weaknesses as: a group member, one working under authority (or peer, pastor, supervisor)? (1500 character maximum):

Discuss how well you think you work with both males and females: in peer settings, in settings where you are the leader, in congregations. (1000 character maximum):

What experiences have you had in working or socializing with people or other races and/or cultures? (1000 character maximum):

Do you have health insurance?:

YesNo

Name of Insurance Company:

Do you take medications regularly?:

YesNo

If yes, please explain (100 character maximum):

Do you have a history of depression, anxiety, bipolar disorder, or other psychiatric issues for which you have been or are currently being treated?:

YesNo

If yes, please share your story (200 character maximum):

Have you been diagnosed with ADD/ADHD?:

YesNo

Are you currently taking medication for this condition?:

YesNo

Do you have any other chronic health issues? (i.e. diabetes, asthma, allergies, high blood pressure, etc.):

Have you ever been convicted of a misdemeanor or felony?:

NoYes

If yes, please explain (200 character maximum):

Have you ever been arrested or convicted of child abuse or a crime involving sexual molestation of a minor?:

NoYes

If yes, please explain (200 character maximum):

Tentative Vocation Choice:

Name of Parent/Guardian:

Are you licensed to drive a car?:

YesNo

Will you have a car this summer?:

YesNo

You must have three reference forms submitted on your behalf (one leader from church, one leader from campus, and one employer or other adult who knows you well). List the names of references to which you will be sending reference forms:

In order to submit your application, you must signify your agreement to the following: 1) I certify that the facts given in my application are true an complete to the best of my knowledge. 2) I understand that consideration for employment is conditioned upon the result of job/personal references, Department Motor Vehicle and Criminal background checks if deemed necessary. I hereby authorize you to verify all information contained on this application with former employers, references, appropriate personnel or resources. I further authorize that any personnel at listed places of employment or references may disclose any and all information regarding my work history, personal characteristics, work habits or other areas of importance to this organization. 3) I furthermore waive the right to sue the aforementioned references for releasing such requested information. 4) I understand that misrepresentations or omission of facts called for shall be considered sufficient cause for dismissal if employed. 5) I understand this authorization and agree to the release and verification of this aforementioned information. 6) I understand that I am required to attend orientation, if selected to serve.:

AgreeDisagree

Enter your full name and date as your electronic signature:

Please upload a photo (headshot preferred) of you:

Upload:

Bible Study
Retreats
Direct Choir
Drama
Fellowship/Recreation
Discipleship Groups
Vacation Bible School
Local Mission Projects
Preaching
Sing Solos
Crafts
Nature Activities
Sunday School
Lifeguard
First Aid
Speaking
Office Work
Tutoring
Children’s Activities
Congregational Singing
Puppet/Clown Ministry