Your Name: (*)

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Your Mailing Address:
(Street Address, City, State, ZIP Code) (*)

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Phone: (*)

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E-mail: (*)

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Citizenship: (*)

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Date of Birth:
(DD/MM/YYYY) (*)

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Home Congregation: (*)

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Pastor's Name: (*)

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Congregation Mailing Address, Phone Number, E-mail and/or Website:

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What is your ministry involvement? (*)

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College or University:

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Year or Year Graduated:

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Major or Degree:

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Profession or Occupation: (*)

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Where employed and how long? (*)

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Are either of your parents Jewish? (*)
- Yes (one)
- Yes (both)
- No

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Were you raised in a Jewish (or Messianic Jewish) home? (*)
- Yes
- No

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Are you: (*)
- Single
- Married
- Divorced
- Widowed

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EMERGENCY CONTACT INFORMATION

Name: (*)

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Relationship: (*)

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E-mail: (*)

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Phone: (*)

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GETTING TO KNOW YOU

Please type your answer to each question clearly and concisely. You may want to type your answers in a separate document, save it, then copy and paste them here.

How did you hear about the internship? (*)

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Why do you want to participate in this program? (*)

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Have you been on a short term missions trip? (Where, when, what?) How did it impact your life? (*)

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Have you raised funds for a missions trip before? Do you plan on doing so for this trip? (*)

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Do you have any physical or emotional challenges that would limit your participation on this program? (*)

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Do you have a criminal record? If yes, please explain the circumstances. (*)

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How and when did you come to follow Jesus as your Messiah? (*)

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Have you ever shared your faith in Messiah with a Jewish person? How did it go? (*)

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If you could create your ideal ministry, what would it look like? (*)

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What are your spiritual gifts? (i.e. administration, encouragement, evangelism, helps, leadership, mercy, teaching..."not sure") and identify any special talents, abilities, and passions you have. (*)

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I understand and agree to the information and responsibilities outlined in
the Personal Responsibility and Doctrinal Statements (*)
- Yes

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