Internship Application

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Where do you worship?*

What city do you worship in?*

Please describe your current church involvement.*

What do you believe about Jesus?*

What do you believe about the Bible?*

How have these beliefs shaped your life?*

Why do you want to intern with Connie Maxwell?*

Do you have a clean driving record?*

Yes

Are you a tobacco product user?*

Yes

Emergency Contact*

Name

Phone

Phone Number

Relationship*

Relationship

Your current employment*

Personal reference 1 (cannot be family member)*

Name and Relationship

Phone

Phone Number

Reference email 1*

Personal Reference 2 (cannot be family member)*

Name and Relationship

Phone

Phone Number

Personal reference email 2*

Pastoral Reference (this can be a staff member or small group leader)*

Name

Phone

Phone Number

Email*

Role*

Role at your church

CAPTCHA