Internship Missionary Application Form

Name*
First Middle Last
Email*
Permanent Address
(Not your BGU address)

Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Date of Birth*
MM slash DD slash YYYY
Gender*
U.S. Citizen?*
Where is your citizenship?*

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Marital Status*
Name of spouse or fiancé*
First Last
Marriage Date/Expected Marriage Date*
MM slash DD slash YYYY
Have you ever been divorced?*
Please give a brief description surrounding the circumstances of your divorce.*
If you have children, please list gender, name, and birth date(s)
Are you currently expecting a child?*
Approximate date of birth*
MM slash DD slash YYYY

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Are you in debt?*
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List your debts
Type/Name of Debt Amount
Please list your debts. Include what the debt is for and the amount.*
Example: Car loan $4000, Student loans, $2000

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Do you have a Home Church?*
Name of your Home Church
Denomination (full name)
How long have you attended?
Minister's/Pastor's name
Home Church's Address
Street Address City State / Province / Region ZIP / Postal Code Country
Home Church's Phone Number
Home Church's Email
Home Church's Website
Name of the church you are currently attending*
Current Church's Address
Street Address City State ZIP Code
Current Church's Phone
Current Church's Email (if no current church, add nochurch@bethanygu.edu to this field)*
Current Church's Website
Name of denomination in which you were raised or if not raised in the church put "none"*
What church ministries or Christian work outside of the church have you been involved with?*
How have you been involved in leading people to Christ and/or discipling others?*
What missions experience do you have?*

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List all education and training you have had such as high school, post high school, technical or apprenticeships, or Bible/discipleship training. Include major, degree, diploma or certificate received.
School Location (City/State) Years Attended Degree/Diploma
List all education and training you have had such as high school, post high school, technical or apprenticeships, or Bible/discipleship training. Include major, degree, diploma or certificate received.*
Example: GED, Central High School, 2007 CPR Certificate, Minneapolis Heart Center, 2011
Do you know any languages other than English?*
Hidden
List languages and check proficiencies
Language Read Write Speak
Please list languages and proficiency*
Example: German - basic, French - fluent
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List any skills, interests, or hobbies you have (i.e. Writing, Sports, Auto repair, Photography/Video, Computer Skills, ect.)
List any skills, interests, or hobbies you have (i.e. Writing, Sports, Auto repair, Photography/Video, Computer Skills, ect.)*
Occupation or Profession*
Hidden
Give details and dates of employment for the last 5 years.
Employer Dates of Employment Job Descriptions Why you left
Give details and dates of employment for the last 5 years. Include employer name, dates of employment, job description, and why you left.
If employed now, may we send a reference form to your present employer?*
Employer Email*
Employer Phone*

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Do you have a sense of calling to ministry and missions? Please share about this.*
Have you ever applied to another mission agency?*
Name of agency*
When did you apply?*
MM slash DD slash YYYY
What is your view of "divine healing"? Are you comfortable laying hands on the sick and praying for healing?*
What has been your experience with the Holy Spirit? Do you feel empowered to live a holy life?*
Have you experienced freedom from the bondage of sin? Please explain.*
Provide a brief (~200 word) testimony of salvation.*

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Describe three of your strengths*
Describe three of your weaknesses*
Rate your overall attitude since coming to BGU*
Describe how your spiritual disciplines have developed*
How would your PT supervisor describe your work ethic?*
When confronted or corrected by a leader, how do you respond?*
How have you demonstrated leadership and initiative while at BGU?*
How well do you manage your time? Are you often stressed or do you plan ahead and keep on top of what is expected of you?*

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Statement of Faith
We have been enlightened, enriched, and edified by many streams of Christian truth, and do not seek to distinguish or divide ourselves from other members of the Body of Christ. This statement, however, describes the fundamental truths in which we believe and by which we seek to live.
- We Believe the Bible to be the only inspired, infallible, and authoritative Word of God, without error in the original manuscripts.
- We Believe that there is one God, eternally existent in three persons: Father, Son, and Holy Spirit.
- We Believe in the deity of our Lord Jesus Christ, His virgin birth, His sinless life, His miracles, His vicarious and atoning death, His bodily resurrection, and His ascension to the right hand of the Father, and His personal return in power and glory.
- We Believe that man was created in the image of God, that he was tempted by Satan and fell, and that all following Adam have sinned and are sinful; that repentance toward God, faith in Jesus Christ, and regeneration by the Holy Spirit are necessary for salvation.
- We Believe that followers of Jesus Christ are called to sanctification through identification with Jesus Christ in His death and resurrection.
- We Believe in the present ministry of the Holy Spirit by whose indwelling, empowering, and gifts the Christian is enabled to live a life of godliness and effective service.
- We Believe in the bodily resurrection of both the saved and the lost; the saved to the resurrection of life and the lost to the resurrection of damnation.
- We Believe that all followers of Jesus are to be committed to the fulfilling of the Great Commission as found in Mt. 28:18-20 and are to be involved in making it possible for the Gospel to be preached to all the peoples of the world.
I have read the Statement of Faith and believe it without reservation. I have trusted in the Lord Jesus Christ as my personal Savior and believe I have been made a new creation in Him.*

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PLEASE NOTE: There are some circumstances in which Bethany is obliged to report to authorities sensitive information provided to us. Please read the following paragraphs carefully and make sure you understand the implications of what you report on this form.

We know that these questions are personal and sensitive. However, the significance of evaluating them and their impact on you emotionally, physically, and spiritually cannot be underestimated.

We take your honesty in answering these questions as a gift of trust, and this page of your application will be treated with strict confidentiality. Select members of Bethany Global University and Bethany Gateways involved in the application and pre-field preparation process will have access to this information. Some information may be summarized and shared with select field staff prior to your arrival on internship. Your personal interview with staff may include discussion from this personal history.

For those questions to which your answer is “yes” but from which you have since found victory, please include your testimony of what catalyst/instrument the Lord used to bring you to a place of wholeness in Him in this area.

On any “yes” answers, please write out brief explanations; if you feel that you cannot write additional details, please write in “Discuss this with me.”

Title IX: Bethany International is subject to the laws of Title IX. This means if any information submitted entails discrimination or harassment pertaining to campus life, mandatory reporting to the Title IX coordinator must take place. Only a Title IX confidential resource can keep these issues undisclosed. You can, however, share information here if you want it reported to the Title IX coordinator or the police. Staff will speak with you personally if further actions need to be taken.

State Mandatory Reporting Laws (NOT TITLE IX): In cases of abuse that occurred to you or someone else as a minor, we would be glad to help you report anything to the authorities of the law, and consider doing so (even if anonymously), as we believe in bringing justice and keeping other minors safe from harm. However, if you do not wish to do so, do not give identifying information about the abuser such as name, employment, or family relationship. You may refer to an abuser, if you do not wish to report, in one of these three categories. 1) A peer, this includes a friend, sibling, relative or acquaintance. 2) An older person, this includes an older sibling or cousin, acquaintance, or stranger. 3) A caregiver, this includes a parent, grandparent, babysitter, teacher, coach, etc. This is to avoid a situation in which we must mandatorily report something you do not wish to be reported to the police, as we would like that decision to remain in your hands. However, if you want it reported you may share identifying information here.
Enter Your Name Below To Indicate That You Have Read The Above Disclaimer
First Last
Have you ever participated in professional and/or pastoral counseling?*
Have you ever abused the use of drugs or alcohol?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever been involved in any occult/psychic activities (These might include New Age religions, witchcraft, ouija boards, secret societies, séances, spirit guides, tarot cards, dark fantasy games/media/literature, fortune telling, astrology, etc.)?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever used/ viewed or been involved with pornographic material (including internet, movies, books, magazines, etc.)?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had a homosexual experience or struggled with same sex attraction?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had pre/extra-marital sexual experience(s)?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Read disclaimer above BEFORE answering. Have you ever been abused verbally, emotionally, physically or sexually (molested or raped)?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had or are you currently struggling with self-injury (cutting, burning, clawing, pulling, etc.) or with an eating disorder? (i.e. anorexia, bulimia, purging, excessive over eating)*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had or are you currently struggling with depression?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had or are you currently struggling with anxiety?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever had or are you currently struggling with moodiness or outbursts of anger?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever experienced suicidal thoughts or attempts?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.
Have you ever been diagnosed with and/or treated for a mental health or emotional disorder?*
Please Explain the circumstances, frequency, duration, and date of last occurrence.

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I, the applicant, declare all information given in this form, and any additional written statements submitted in the application process, to be true and accurate to date. I understand any misrepresentation of information may result in immediate disqualification for internship.
Signature*
Date*
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Item Checked Above	Frequency/Dates of Occurrence	Type(s) of Treatment	Dates of Treatment	Long Term Effects And Restrictions

Additional Item	Dates of Occurrence	Type(s) of Treatment	Dates of Treatment	Long-Term Effects/Restrictions

Type of Medication	Dosage	Reason For Medication	Does A Doctor Oversee The Use Of This Medication? (Explain)

Global Internship Application

Step 1 of 11 - Basic Info

Statement of Faith

Type/Name of Debt	Amount

School	Location (City/State)	Years Attended	Degree/Diploma

Language	Read	Write	Speak

Employer	Dates of Employment	Job Descriptions	Why you left