Please select the internship rotation you are applying for
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Internship 2 (9/25/17 - 10/29/17)
Internship 3 (11/5/17 - 12/10/17)
I will need housing during my stay in San Diego.
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Yes
No
Full Name
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First Name
Last Name
Gender
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Male
Female
Phone
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Country
(###)
###
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Current Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Country of Citizenship
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Do you have a current passport?
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Yes
No
Is English your first language?
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Yes
No
IF NOT, please rate your spoken English:
fluent
advanced
intermediate
beginner
Please rate your written English:
fluent
advanced
intermediate
beginner
Please rate your understanding of English in daily communication:
fluent
advanced
intermediate
beginner
Highest level of education:
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Field of study:
Graduation date:
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MM
DD
YYYY
Did you previously attend a ministry school, seminary, or DTS?
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Yes
No
If yes, please name the school or organization:
Are you currently employed?
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Yes
No
IF YES, what is your occupation?
Current employer:
Employer phone:
Country
(###)
###
####
May we contact your employer?
Yes
No
What field do you have the most experience in?
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How many years of experience do you have in this field?
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Are you planning to continue in this field?
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Yes
No
Will you be able to pay the deposit within 3 days of acceptance?
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Yes
No
Will you be able to pay tuition in full by the start of the internship?
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Yes
No
Please describe how you plan on financing for your internship? And your personal expenses?
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Do you already have financial support from family, friends, church, or community? Please, explain:
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Current marital status:
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engaged
married
single
divorced
widowed
If married, spouse's name:
If married, is your spouse supportive of your decision to join the internship?
Yes
No
Have you been separated or divorced?
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Separated
Divorced
Neither
Do you have any children?
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Yes
No
If yes, children’s names and date of birth:
A
Are any family members joining the interning, as well?
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Yes
No
If yes, list who:
If you are living at home with your parents, is your family supportive of your decision to join the internship?
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Yes
No
If not, please explain:
Mother’s full name:
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First Name
Last Name
Father's full name:
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First Name
Last Name
Full name of emergency contact 1:
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First Name
Last Name
Relationship with emergency contact 1:
*
Address of emergency contact 1:
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone number of emergency contact 1:
*
Country
(###)
###
####
Email address of emergency contact 1:
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Full name of emergency contact 2:
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First Name
Last Name
Relationship with emergency contact 2:
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Address of emergency contact 2:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone number of emergency contact 2:
*
Country
(###)
###
####
Email address of emergency contact 2:
*
Will you have medical insurance during your time with us?
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Yes
No
Do you have any illnesses?
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Yes
No
If yes, please list and describe them:
Have you received treatment for any diagnosed physical, emotional or mental conditions in the last 5 years?
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Yes
No
If yes, please list the diagnosis, each medication and when it was last used.
Do you have any undiagnosed physical, emotional or mental limitation that you might experience during the course of the internship? (such as phobias, anxieties, etc.
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Yes
No
If yes, please list these conditions here:
Have you used tobacco in the last 12 months?
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Yes
No
If yes, please explain:
Have you consumed alcoholic beverages in the last 12 months?
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Yes
No
If yes, please explain:
Have you used drugs within the last 24 months?
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Yes
No
If yes, please explain:
Have you been involved with pornography within the last 12 months?
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Yes
No
If yes, please explain:
Have you been sexually active in the last 2 years? Singles (with ___Yes ___No anyone) marrieds (with anyone other than your spouse).
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Yes
No
If yes, please explain:
Have you struggled with homosexual behavior or same sex attraction in the last 5 years?
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Yes
No
If yes, please explain where you are with the process:
Have you exhibited any self-destructive behavior or habitual problems within the last 5 years? (i.e. eating disorder, cutting, compulsive lying, etc.)
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Yes
No
If yes, please explain:
Have you ever been arrested?
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Yes
No
If yes, please explain:
Have you ever been involved in the occult, witchcraft, or cults?
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Yes
No
Have you ever been involved in the occult, witchcraft, or cults?
When did you accept Jesus Christ as your personal savior?
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How would you describe your relationship with Christ?
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Growing
Inconsistent
Briefly describe how you were saved:
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Have you been baptized in water?
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Yes
No
If yes, please tell us the date:
MM
DD
YYYY
Have you been baptized in the Holy Spirit?
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Yes
No
Unsure
If yes, briefly describe your experience:
What is your main denominational background?
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Do you have a home church?
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Yes
No
If yes, are you a member?
Yes
No
If yes, tell us about your relationship with the pastor who knows you best at your home church?
Church name:
Pastor’s name:
First Name
Last Name
Church phone number:
Country
(###)
###
####
Church address:
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Do you attend Church regularly?
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Yes
No
If yes, how long have you been attending there?
In what capacity are you currently serving your local church?
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Have you recently left another church?
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Yes
No
Please, explain if there were unresolved issues:
List and explain any Christian service you have done:
*
Please, give a brief description of your Christian journey:
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How did you hear about the Elisha Revolution Internship?
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Please, explain why you would like to be a part of the Elisha Revolution Internship?
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What areas would you like to grow in?
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What are you passionate about?
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What is your greatest strength?
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What is your biggest fear?
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What do you see yourself doing with what you learn at Elisha Revolution Internship?
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What do you see yourself doing in 10 years?
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What do you feel you are called to and what are some of the prophetic words that you have received over your life?
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Have you read any books by Jerame or Miranda Nelson?
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Yes
No
If yes, please list them:
Have you been attending, or watching the Fire and Glory Outpouring?
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Yes
No
If yes, please explain how you were touched and what you grew in:
Your personality type on Myers Briggs Test:
Your personality type on DiSC Test:
List any instruments you play:
What does fun look like to you?
*
Tell us about the last risk you took:
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Tell us about the last feedback you received and how you implemented such feedback to grow:
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Full name of reference 1:
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First Name
Last Name
Relationship with reference 1:
*
Years you have known reference 1:
*
Address of reference 1:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email address of reference 1:
*
Phone number of reference 1:
*
Country
(###)
###
####
Full name of reference 2:
*
First Name
Last Name
Relationship with reference 2:
*
Years you have known reference 2:
*
Address of reference 2:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email address of reference 2:
*
Phone number of reference 2:
*
Country
(###)
###
####
Text Area 39
Address History
*
Please list complete address information going back 7 years to date.
Full Name
*
First Name
Last Name
Other Names Used
Date of Birth
*
MM
DD
YYYY
Gender
*
Male
Female
Social Security Number
*
Mobile Phone
*
Country
(###)
###
####
Driver’s License Number
State
