Children's Ministry Internship Application

General Information

Semester applying For: *

Year applying for: *

Your Name *

Phone *

Email Address *

Please attach a .jpg of yourself *

Did anyone refer you to us? If so, who? *

Education History *

	Current School	Major	Minor	Projected Graduation Month and Year
-	Current School	Major	Minor	Projected Graduation Month and Year

Please list three references who can provide information about your character and work ethic.

Reference #1 - Pastor/ Mentor Name: *

Reference #1 Email: *

Reference #2 - Employer Name: *

Reference #2 Email: *

Reference #3 - Friend Name: *

Reference #3 Email: *

Briefly describe your family background. *

Briefly describe how you became a Christian. *

How do respond to personality differences and communication difficulties? *

Have you ever plead guilty, "no contest" or been convicted of any criminal offense? If yes, please explain. *

No

Yes Yes

Have you ever plead guilty, "no contest" or been convicted of child neglect or abuse? If yes, please explain. *

No

Yes Yes

Have any complaints or allegations of misconduct involving children or youth been made against you? If yes, please explain. *

No

Yes Yes

Have you ever participated (or engaged) in misconduct (sexual or otherwise) involving children? *

No

Yes

Have you had any traffic tickets or been in any vehicle accidents in the past three years? If yes, please explain. *

No

Yes Yes

Signature *

Date *