Date of Application
*
MM
DD
YYYY
Name
*
First Name
Last Name
Email Address
*
Do you have a Facebook page?
*
Yes
No
Facebook profile address
Cell Phone Number
*
(###)
###
####
Gender
*
Male
Female
SRM Availability
*
Are you available to live in Washington Park in Montgomery, Alabama, and serve as a full time missionary during the required dates of the SRM?
Yes
No
Eligibility
*
Are you 18 years of age or older, eligible to work AND a US Citizen, OR authorized to work in the US on an unrestricted basis?
Yes
No
Have you ever been convicted of any offense other than a minor traffic violation?
*
Yes
No
Type of Offense
Date of Offense
MM
DD
YYYY
Place of Offense
If you have been convicted of more than one offense, please list additional offenses, dates, and places.
Have you ever had your license/ credential suspended, revoked, or had any other adverse action taken against you?
*
Yes
No
Have you ever worked with children before?
*
Yes
No
If you have worked with children before, please briefly explain.
Do you enjoy working with children?
*
Yes
No
Sometimes
I can tolerate them for a summer
Never had any real experience
Would you prefer to work with children or adults?
*
Children
Adults
No preference
Do you have any special skills or talents that could possibly be taught as an activity for our youth (ie. art, music, dance, sports, etc)?
Do you have any other skills that could be helpful that doesn't involve working with kids daily (ie. administration, media, building construction, etc.)?
Are you currently enrolled in college?
*
Yes
No
Name of college/ university and location
Have you ever been suspended or expelled?
*
Yes
No
If you have been suspended or expelled before, explain why.
Describe specialized training, apprenticeship, skills
What is your strongest subject in school, and why?
*
Please list any special honors and achievements
Name of education reference
First Name
Last Name
Contact phone number of education reference
(###)
###
####
Relationship to education reference
Email of educational reference (only use professional/ work email, not personal email)
*
How long have you known educational reference?
Have you ever had a job?
*
Yes
No
Supervisor's Name
First Name
Last Name
Supervisor's Phone Number
(###)
###
####
Reason for leaving job
Description of job duties
Are there any previous employers we SHOULD NOT contact?
*
Yes
No
If not, why?
Name of work reference
First Name
Last Name
Phone number of work reference
(###)
###
####
Relationship to work reference
How long have you known work reference?
Do you consider yourself a Christian?
*
Yes
No
How often do you attend church?
*
Weekly
Monthly
Other
I don't attend at all
How often do you attend parachurch/ campus ministries?
*
For example, Campus Outreach, Campus Crusade for Christ, Baptist Campus Ministries, Wesleyan Foundation, Catholic Student Services, etc
Weekly
Monthly
Other
I don't really attend at all
If you noted OTHER in the above questions, please explain
Name(s) of your church/ parachurch organization
Denomination of your church/ pararchurch organization
Briefly describe your salvation experience and any experiences that have brought you into a deeper relationship with Christ.
*
Please list any church/ Christian work or ministry in which you are involved.
Pastor/ Minister's Number
(###)
###
####
May we contact your pastor/ youth pastor/ campus minister/ parachurch organization minister?
*
Yes
No
If someone were to ask you how to get into Heaven, what would you say?
*
If someone were to ask you how to get right with God, what would you say?
*
Briefly describe your thoughts regarding working with others (colleagues and/or students) of other denominational beliefs.
*
The role of the Holy Spirit in the life of a believer
*
The purpose of the Bible in the life of a believer
*
Briefly describe your routine of personal Bible study and prayer
*
Name of church reference
First Name
Last Name
Phone number of church reference
(###)
###
####
Relationship to church reference
How long have you known the reference?
Why do you want to participate in the SRM? What do you expect to get out of it?
What are your strengths and weaknesses?
What do you plan to do after graduation? How does what you know about the SRM fit into those plans?
Name of personal reference
First Name
Last Name
Phone number of personal reference
(###)
###
####
Relationship to personal reference
How long have you known personal reference?
How serious are you about coming attending the SRM with Common Ground Montgomery?
*
Just investigating; not 100% sure
I want to come, but support raising concerns me
I'm excited about coming, but Jesus "ain't" confirmed it yet
I'm 100% in, see you in May, homie!
Do you need financial assistance?
There are a limited amount of scholarships available to help students experience the SRM. If you think you will be unable to raise the funds necessary for this but still want to attend, check this box. The staff will examine each application on a case-by-case basis to award these limited funds. PLEASE DO NOT check this simply because you don't want to raise funds or if you think don't "have the personality" to raise funds - there is a difference between being unable and unwilling.
Yes, I will be unable to attend SRM without assistance
No, I'm pretty sure/confident I will be able to raise the money on my own