Personal Information
NAME BIRTH DATE SOCIAL SECURITY # PARENT/GUARDIAN (NAMES) (if applicable) HOME ADDRESS (include city, state and zip) PHONE # EMAIL ADDRESS NUMBER OF BROTHERS/SISTERS Select 0 1 2 3 4 5 6 7 8 9 10 11 12
NAME
BIRTH DATE
SOCIAL SECURITY #
PARENT/GUARDIAN (NAMES) (if applicable)
HOME ADDRESS (include city, state and zip)
PHONE #
EMAIL ADDRESS
NUMBER OF BROTHERS/SISTERS Select 0 1 2 3 4 5 6 7 8 9 10 11 12
University/College Information
NAME OF INSTITUTION PRESIDENT OF INSTITUTION MAJOR CLASSIFICATION: FR SOPH JR SR GRADUATION DATE:
NAME OF INSTITUTION
PRESIDENT OF INSTITUTION
MAJOR
CLASSIFICATION: FR SOPH JR SR
GRADUATION DATE:
United Methodist Church Membership
CHURCH NAME: CHURCH PASTOR: CHURCH ADDRESS (Street Address, City/State/Zip) JURISDICTION: ANNUAL CONFERENCE: Activities/Memberships (please list on separate lines) Awards, Honors, Travels etc. (please list) Assignments with UMC
CHURCH NAME:
CHURCH PASTOR:
CHURCH ADDRESS (Street Address, City/State/Zip)
JURISDICTION:
ANNUAL CONFERENCE:
Activities/Memberships (please list on separate lines)
Awards, Honors, Travels etc. (please list)
Assignments with UMC
More About You
ARE YOU APPLYING FOR ANY OTHER UNITED METHODIST PROGRAMS? Select Yes No If yes, please list the name of the program.
ARE YOU APPLYING FOR ANY OTHER UNITED METHODIST PROGRAMS? Select Yes No
If yes, please list the name of the program.
WITH WHAT UNITED METHODIST CHURCH HAVE YOU CONNECTED IN LOCAL AREA (I.E. COMMUNITY WHERE ATTENDING COLLEGE) TO PROVIDE NURTURE AND SUPPORT WHILE AWAY FROM HOME COMMUNITY?
IN WHAT CAPACITIES ARE YOUR TALENTS BEING USED IN CHURCH AND/OR COMMUNITY? (I.E. SUNDAY SCHOOL TEACHER, CHILDREN’S SERMON, BIBLE STUDY, TUTORING AFTER SCHOOL, COMMUNITY SERVICE PROJECTS, SOUP KITCHEN, UNITED METHODIST CENTER, BATTERED WOMEN SHELTER, HOMELESS SHELTER, OUTREACH MINISTRY, ETC.)
WHAT ARE YOUR PROFESSIONAL GOALS? WHAT ARE THE REASONS FOR CHOOSING THIS GOAL? WHY DID YOU CHOOSE YOUR PARTICULAR COLLEGE OR UNIVERSITY?
WHAT ARE YOUR PROFESSIONAL GOALS?
WHAT ARE THE REASONS FOR CHOOSING THIS GOAL?
WHY DID YOU CHOOSE YOUR PARTICULAR COLLEGE OR UNIVERSITY?
REFERENCES
REFERENCE #1: NAME, ADDRESS (CITY/STATE/ZIP) PHONE NUMBER: EMAIL ADDRESS: RELATIONSHIP TO YOU: REFERENCE #2: NAME, ADDRESS (CITY/STATE/ZIP) PHONE NUMBER: EMAIL ADDRESS: RELATIONSHIP TO YOU:
REFERENCE #1: NAME, ADDRESS (CITY/STATE/ZIP)
PHONE NUMBER:
EMAIL ADDRESS:
RELATIONSHIP TO YOU:
REFERENCE #2: NAME, ADDRESS (CITY/STATE/ZIP)
Biographical Statement
Write a 2-3 paragraph statement describing your personal history, philosophy of life, religious development and vocational goals including what has influenced you most in major choices. (Use this form and attach additional pages if needed)
Photograph The photograph that you send will be reproduced for promotional purposes. DO NOT SEND a photograph that is copyrighted. Check carefully for embossed names in the lower right/left hand corners and the back for watermarks. Also send a digital copy to the BCF office.
Video guidelines
Deadline for application In order for your application to be considered complete, it must have all of the following together in one package:
Please keep in mind that all applications are due by November 1, 2011. (No exceptions) Evaluations will be completed by November 14, 2011. If necessary, identified candidates may be asked to come to Nashville for personal interviews. You will be notified first through email and then followed up with a phone call by November 18, 2011.
Notification You and the office of your college or university president will first receive notification of your invitation to participate in orientation and training. Students who are selected will need to confirm their intent to participate in orientation, itineration and debriefing. Parents and/or guardian signatures will be required of all students 18 and under who are selected for the itineration program.
Evaluation of presentation Our areas of concern as we critique your presentation:
Chaplain Information
NAME, ADDRESS (CITY/STATE/ZIP) PHONE NUMBER: EMAIL ADDRESS:
NAME, ADDRESS (CITY/STATE/ZIP)
Signatures
Signature of Applicant ____________________________________________________ Date _________________________
President's Signature ____________________________________________________ Date _________________________
Campus Chaplain _______________________________________________________ Date _________________________