*Denotes Required Field * Title Central Heights Intern Program Application * First Name: * Last Name: * Street Address: * CIty * Province/State/Region * Postal/Zip Code * Country * Email: * Phone: ( ) - * Date of Birth: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 * Do you have a valid driver's license? Yes No * Do you own a vehicle? Yes No * Marital Status Single Dating Married If dating, how long? * Name of Emergency Contact: * Relationship to Emergency Contact: * Emergency Contact phone #: ( ) - EDUCATION * Name of High School: * Name of Post Secondary School (College, University or Other School): * Date of Graduation: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 * Diploma/Degree Received: * Other Theological Training: * Date of Graduation: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 CHURCH INFORMATION * Home Church: * Church Mailing Address: * Pastor's Name and Phone Number: * How long have you been attending this church? * Do you currently serve at your home church? Yes No If yes, in what areas? * Are you involved in a community group? Yes No PERSONAL INFORMATION * Please share the story of how and when you committed your life to Jesus Christ: * Please share how and when you were baptized: * Tell us how you spend time with God and share with us one thing God has been speaking into your life recently: * What are you best at? * What do you struggle with? * Why do you feel the Central Heights Church Intern Program is a good fit for you? * What do you desire to learn from your participation in the Intern Program? * After this internship is completed, what do you hope to do? MINISTRY INFORMATION * Which ministry area is your first choice? Please select an option Worship Tech Women's Ministries Seniors Ministry Discipleship Ministries Connection and Community Ministries Kids Ministry Youth Ministry Young Adults Ministry * Which ministry area is your second choice? Please select an option Worship Tech Women's Ministries Seniors Ministry Discipleship Ministry Connection and Community Ministries Kids Ministry Youth Ministry Young Adults Ministry If worship is a choice, please email your audition video to dmorelli@centralheights.ca REFERENCES Please list people you have known for at least three years and who are not family members. Reference #1 * First and Last Name: * Phone: ( ) - Relationship to Reference: Reference #2 * First and Last Name: * Phone: ( ) - * Relationship to Reference:
