Campus Missionary-in-Training at Chi Alpha CMIT Program

First Name *

Last Name

Email *

Phone *

Address *

Date of Birth *

Gender *

City, County, State of Birth *

Country of Citizenship *

Social Security Number *

If you have a Green Card, what type?

Primary Language Spoken *

Secondary Language Spoken, if any

Marital Status at time of CMIT Internship *

Have you ever been:

Separated
Divorced
Widowed

If you have ever been separated, divorced, or widowed, please briefly provide more information.

List any unmarried children (ages 22 and younger) who are still living at home. List their full name, birth date, social security number, and gender. If you are expecting, please note the due date.

Full Name of Spouse or Fiancée

Phone of Spouse or Fiancée

Email of Spouse or Fiancée

Birth Date of Spouse or Fiancée

City, County, State of Birth of Spouse or Fiancée

Country of Citizenship of Spouse or Fiancée

Social Security Number of Spouse or Fiancée

If Spouse or Fiancée has a Green Card, what type?

Primary Language Spoken by Spouse or Fiancée

Secondary Language Spoken by Spouse or Fiancée, if any

Marital Status of Spouse or Fiancée at time of CMIT Internship

Has Your Spouse or Fiancée ever been:

Separated
Divorced
Widowed

If your spouse or fiancée has ever been separated, divorced, or widowed, please briefly provide more information.

College Attended by Spouse or Fiancée, including degree and graduation date.

Present Occupation of Spouse or Fiancée

To be answered by Spouse or Fiancée: Is there any reason or concern that might make it unwise for you and/or your spouse or fiancée to participate in a CMIT internship?

Names of Applicant's Parents *

Address of Applicant's Parents *

Occupation of Applicant's Father *

Occupation of Applicant's Mother *

Church Membership of Applicant's Parents *

Do you want your parents notified in the event of an emergency? *

What biblical and theological education have you had to date? *

What has been your involvement in secular campus ministry? Include ministry names and locations and describe tasks and responsibilities. *

Outside of secular campus ministry, what other ministry/leadership responsibilities have you had? List tasks, dates, places, and responsibilities. *

Do you fully subscribe to the National Chi Alpha mission statement? *

Do you currently hold ministerial credentials with the Assemblies of God? *

If credentialed, which credential do you hold?

If credentialed, provide the date and district of your most recent credentials.

If you do not have ministerial credentials, would you be willing to apply?

Describe where and when (the date) you were converted to Christ. *

Have you been baptized in water by immersion? *

Have you received the baptism in the Holy Spirit with the evidence of speaking in tongues? *

Describe where and when (the date) you received the baptism in the Holy Spirit.

Describe your normal devotional life by content and format. *

List five books and/or periodicals you read recently that impressed you. *

"A person is saved from their sins by grace through faith alone and not as a result of works." Indicate your level of agreement and please attempt to avoid neutral responses. *

"People who have not received Jesus Christ as savior are eternally lost and without hope." *

"There are many paths to God and all religions basically say the same thing." *

"You can trust the biblical Scriptures because they are reliable." *

"Physical healings and miracles ceased after the first century Church was established and after the formation of the New Testament canon." *

"Personal affluence and wealth is a sign of the blessing of God." *

"Jesus Christ will literally come again." *

"You must speak in tongues to be saved." *

Name of College or University attended by Applicant *

City, State of Applicant's College or University *

Dates Applicant attended College or University *

Degrees or Diplomas achieved by Applicant *

Applicant's Final GPA from College or University *

List any special awards and/or areas of academic excellence.

Provide the last five years of your occupation/employment history with dates. *

Have you ever been discharged or asked to resign from an employment or ministry position? *

If you have ever been discharged or asked to resign from an employment or ministry position, please explain.

List any serious illnesses, emotional difficulties, learning disabilities, or problems of substance abuse which you, your Spouse or Fiancée, or your children have now or in the past.

Have you ever been convicted of a crime? *

If you ever been convicted of a crime, please explain.

What is your sexual orientation? *

Describe your primary strengths of character. *

I have a long-term commitment to campus missions. *

I have a consistent devotional time. *

I operate in the spiritual gifts. *

I am a person who honors those in authority above me. *

I am a leader that people willingly or voluntarily follow. *

I am a person of initiative and self-motivation. *

I am creative and innovative. *

I am an energetic person. *

I manage stress well. *

I show no signs of abusive behavior towards myself or others. *

I am a team player and network with others easily. *

I am sensitive to the ideas and feelings of others. *

I have good person-to-person communication skills. *

I am an open, transparent person. *

I am a critical and creative thinker. *

I am an empathetic listener. *

I help others heal their broken relationships. *

I use non-manipulative persuasion when leading others. *

I see tomorrow's consequences from today's actions. *

Do you sense God calling you to full-time campus missions? Please explain. *

How do your parents view your intentions to become a CMIT? Please explain. *

Are you willing to make a 9-month commitment to a CMIT internship? *

What do you hope to gain from your CMIT internship? Please be specific. *

As of today, what do you hope to do immediately following the CMIT internship? *

How will you provide for your financial needs during the CMIT internship? *

Do you have a home church willing to help you financially? *

Do you have debt? *

If yes, please list the total amount and type of each debt (school loan, credit card, etc) and describe your payment plan during the CMIT program.

Emergency Contact Name *

Emergency Contact Address, City, State, and ZIP *

Emergency Contact Phone Number *

Emergency Contact Email Address *

Emergency Contact's Relationship to Applicant *

A nationally-approved CMIT should attend Reach the U Institute (RUI) prior to the beginning of their CMIT internship. *

If you are unable to attend RUI prior to the start of your CMIT internship, please explain why.

My first choice for CMIT internship location is: *

My second choice for CMIT internship location is: *

My third choice for CMIT internship location is: *

Please enter here a biographical sketch of 300-400 words outlining the primary formative events of your life. *

Please attach a scanned copy of your completed CMIT Legal Document Packet (CMIT Agreement & Authorization, Background Investigation Consent, Spouse Background Investigation Consent, and Conciliation and Arbitration Agreement) with all signatures included. *

Please attach a scanned copy of your Social Security or Green Card. *

Please attach a scanned copy of your Drivers License. *

Please attach a recent photograph of yourself. *

Character Reference #1: Campus Missionary/Director Name *

Character Reference #1: Campus Missionary/Director Address, City, State, and ZIP *

Character Reference #1: Campus Missionary/Director Phone Number *

Character Reference #1: Campus Missionary/Director Email Address *

Character Reference #1: Campus Missionary/Director Position and/or Relationship to Applicant *

Character Reference #2: Other Ministry Leader Name *

Character Reference #2: Other Ministry Leader Address, City, State, and ZIP *

Character Reference #2: Other Ministry Leader Phone Number *

Character Reference #2: Other Ministry Leader Email Address *

Character Reference #2: Other Ministry Leader Position and/or Relationship to Applicant *

Character Reference #3: Employer Name *

Character Reference #3: Employer Address, City, State, and ZIP *

Character Reference #3: Employer Phone Number *

Character Reference #3: Employer Email Address *

Character Reference #3: Employer Position and/or Relationship to Applicant *

On what date are you available to begin the CMIT program? *

Have you paid your $30 CMIT application fee? *

See all the jobs at Chi Alpha CMIT Program here: http://cmit.recruiterbox.com/jobs

Application Form