2017 Intern Application Form - Summer Impact
Name
Your answer
Position of Interest
(check all that apply)
Required
Present Address
(Please include street address, city, state, and zip code)
Your answer
Contact Phone Number
Your answer
Email Address
Your answer
Date of Birth
MM
/
DD
/
YYYY
Sex
Place of Birth
Your answer
Citizenship
Your answer
Marital Status
Church Membership
(Church name and denomination)
Your answer
Name of Pastor
Your answer
Church Address
Your answer
Church Telephone Number
Your answer
What UM Annual Conference is your church part of?
(if applicable)
Your answer
What has been your experience in the life and mission of the church?
Your answer
How has your participation in the church impacted your life?
Your answer
Describe your volunteer and community ministry experience. How have you served with people who are experiencing homelessness, hunger, poverty, etc?
Your answer
Are you willing to live and work under conditions that may be uncomfortable and/or unfamiliar?
Describe an experience that has required your flexibility and sensitivity to others.
Your answer
The culture and leadership of our community ministry partners and church can be very different from one another. You will have the opportunity to serve alongside HPC church members and 8-10 community ministry partners. Describe your experience with serving within cultures different from your own.
Your answer
Have you ever been convicted of any crime(s) in any jurisdiction in the United States or any other country?
(A conviction record will not necessarily disqualify an applicant)
If you answered "yes" to the above question please state the nature of the offense, when, where, and disposition.
(If you answered "no" please type: n/a in the space below.)
Your answer
What skills do you bring to Summer Impact?
(Check all that apply)
Required
Of the skills checked above, list your top three based on amount of knowledge/experience.
Your answer
Describe your current understanding of the needs of people within the inner city of Cincinnati.
Your answer
How do you anticipate sharing your experience with others at the end of your internship?
Your answer
Person to notify in case of emergency.
(List name, address, phone, email, and your relationship to that person)
Your answer
List all educational, vocational, or other specialized training schools which you have attended, beginning with the most recent.
(List school name, location, dates attended, graduation year, and field of study)
Your answer
Current Employment Status
(Select all that apply)
Required
Please list your significant employment positions, starting from the most recent.
(List dates of employment, employer, location, and type of work)
Your answer
You are responsible for sending reference forms to three people. You may select any three people (except relatives), but they MUST BE SOMEONE WHO KNOWS YOU WELL. (Examples of people who would make good references would be: pastor, employer, supervisor, teacher, etc). Please list the three individuals you will send references to below.
(Include first an last name, email, relationship to you, and phone number)
Your answer
In what religious, civic, scholastic, or professional organizations do you participate?
Your answer
What religious, civic, scholastic, or professional awards or honors have you received?
Your answer
What are your hobbies?
Your answer
What were your favorite reading materials during this past year? Books? Magazines?
Your answer
Where are your favorite places to eat?
Your answer
Additional comments you wish to share
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