2017 Returning Intern Application - Summer Impact
Name
Your answer
Position of Interest
(check all that apply)
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Present Address
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Contact Phone Number
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Email Address
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Date of Birth
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DD
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YYYY
Sex
Place of Birth
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Citizenship
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Marital Status
Church Membership
(Church name and denomination)
Your answer
Name of Pastor
Your answer
Church Address
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Church Telephone Number
Your answer
What UM Annual Conference is your church part of?
(if applicable)
Your answer
What year(s) were you a Summer Impact Intern?
Your answer
How have you grown since you were a Summer Impact Intern?
Your answer
This year, what will be different? What will you do/hope to do differently?
Your answer
How will you step into a new team?
Your answer
If you could wave a magic wand, what would be something Summer Impact could adapt or change during the summer of 2017?
Your answer
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)
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Additional comments you wish to share
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