Intern Year Application 2017

Contact Information

Full Name as on ID
Preferred Name/Nickname
Date of Birth
Mobile Phone No.
Email Address
Street Address
Post Code
Suburb
Postal Address
(leave blank if same as above)

Emergency Contact Information

Name
Contact Phone No
Address
Relationship to you
Email address

Medical Information

Do you have any medical conditions that we should be made aware of? / YES Or NO (please circle)
If Yes, please give details and the required response.
Do you have any dietary requirements? Please list.

Local Church / Congregation Information

Church and Denomination Name
Address
How long have you attended here?
Name of your Lead Minister/Pastor/Priest
Email Address
Contact Phone No.
Other Leader/Referee from your church
(Youth Pastor, Mentor)
Contact Phone No.
Office Use Only --
Referees Called & Notes

Where do you currently serve and/or lead in your church or community ministry. Please choose up to 3 key roles.

Role
(e.g. welcomer, bbq in local school, worship leader, youth leader, etc.) / Description / Approx.hrs/wk(meetings, prep, serving, etc.)

Other Passions/Interests/Hobbies

Intern Year 2017 Application Letter

Please attach a 1 page letter of application as a Word Document.

Include the following:

1.A short paragraph of how you came to believe in Jesus Christ.

2.Why you are enrolling in Intern Year in 2017.

3. What your hopes are for the year.

Other Study and Commitments

What other commitments will you have during 2017. Please include other study, work, outside commitments during the year.

Availability

Students are expected and encouraged to be committed to Intern Year and their local church for the whole year. We understand that illness and other factors may contribute to absence during the year. We try to be flexible to accommodate commitments especially church and work commitments. Do you foresee any Wednesdays or other dates where you will not be present? Provide details below.

Application Check List

Interview with Coordinator
Intern Year Application Form Completed
Application Letter (Word Doc Attached)
ACD Enrolment Form (to be completed after application approved)
RH White Fund Scholarship Forms if required
Direct Debit Form (to be completed after application approved)
Check all Forms are Signed
Send with attachments to VET coordinator

Signature

I hereby confirm that this information is accurate to the best of my knowledge. I understand that my enrolment in the Intern Year and the Certificate IV in Christian Life and Ministry is subject to:

1. Approval of my application

2. An orientation session at the 34 Lipsett Terrace, Brooklyn Park Campus.

Please note: The direct debit form will be provided to you once your application has been submitted and is successful.

Applicant Name: ______

Applicant Signature: ______Date: ______

Church Leader Referee Signature: ______

Church Leader Name: ______

Please return to:

Intern Year Coordinator –

Intern Year Coordinator

Uniting College

34 Lipsett Terrace

Brooklyn Park SA, 5032.

Forms returned by24th July, 2017.

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All the information recorded on this form is collected and managed in accordance with the Uniting Church Privacy Policy. This information has been collected for the primary purpose of Uniting Collegeand may be used for any activities,conducted or promoted by Uniting College. If you have any concerns please email

Office Use Only

Date Received: