Synergistic Launch Intern Program
ApplicationThis application is for those interested in the Lilly Grant Intern Program – Aug 2016-July 2017Please submit completed applications to . We will notify you when we receive your application within 72 hours. The deadline for this application is March 31, 2016.

PART 1 – GENERAL BACKGROUND
I. GENERAL INFO
Last Name: / First Name: / MI:
Address:
City: / State: / Zip:
Home Phone: / Cell Phone:
Email:
Birth date: / Gender: / Relationship Status:(Select one from pull down)SingleDatingEngagedMarriedDivorced
Children:
II. EDUCATION
High School: / Year of Graduation:
College Name: / Major: / Year of Graduation:
Address: / GPA:
College Name: / Major: / Year of Graduation:
Address: / GPA:
III. EMPLOYMENT
Current Employer: / Position:
Address: / Hrs/Week:
Previous Employer: / Position:
Address: / Hrs/Week:
IV. BEHAVIOR
Discuss any level of involvement with drugs, alcohol, gambling, pornography, sexual sin or illicit behavior over the last 12 months:
Have you been accused of any felonies or had to serve time in prison or jail? If so, please explain:
Do you currently have an accountability partner/group? If so, how often do you meet?
Are you willing to undergo a background check? Yes No
V. REFERENCES (at least one being a church leader)
Name: / Role:
Address: / # of Years Known:
Email: / Phone #:
Name: / Role:
Address: / # of Years Known:
Email: / Phone #:
Name: / Role:
Address: / # of Years Known:
Email: / Phone #:
PART 2 – PERSONAL & MINISTRY BACKGROUND (No right or wrong answers, we just want to get to know you)
What ministry tracks have you served in or are interested in? (Check all that apply)
Ministry Area Previous: Currently: High Interest: Possible Interest:
College
Children’s Ministry
Youth Ministry
Young Adult
Worship
Pastoral Ministry
Technology/Communications
Other (specify)
Describe your current church/ministry involvement.
Describe your previouschurch/ministry involvement.
Are you interested in exploring the possibility of full-time ministry as an occupation? Why?
Describe two of your strengths and one area for improvement.
Have you taken the DISC or Myers-Briggs Type Indicator, and/or StrengthFinders? If so, what were your results?
Describe any leadership positions you have held in the past four years.
What are your goals for this internship?
PART 3 – SPIRITUAL JOURNEY
Briefly give your personal testimony (approx 1 page). Include the time leading up to salvation, your present walk with the Lord, and your current understanding of your calling or aspirations for the future.
Church Background – Please describe your church background and any essential characteristics of a church where you might be interested in attending or serving.
Church Denomination – Please give us what denomination you have been a part of or the closest affiliated with doctrinally.

PART 4 – APPLICANT SIGNATURE

I, , certify that the information given in this application is true and correct to the best of my knowledge.

Electronic SignatureDate

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